The Gut Super-Special: Eating Camel Poop, Weird Constipation Causes, Pig Whipworms & More: How...

Welcome to the Ben Greenfield Fitness Show. Not just any show, but today, a show about pooping. If you want to fix your gut, fix constipation, optimize your digestion. I'm going to trademark that term, optimize your digestion. You're going to want to keep listening and a few other things. First of all, we are switching the podcast format up a little bit in case you didn't hear, meaning in case you aren't stalking Ben Greenfield Fitness on Facebook. Basically, we're going to do one kind of like slightly longer interview every Wednesday and then also alternate that with our normal Q and A super specials every other Wednesday. That will be something that we slowly, gradually roll into here, going into whatever it is, the fall of 2016, or as all my cool business friends say, the next quarter. This also means that when I release these longer, slightly more detailed interviews for.

You, I will have a chance to.

Go over a things prior to giving you the actual interview. And I promise these will be super quick. But I have been getting some questions specifically about Michael Phelps and cupping.

That is question number one.

I've been getting a lot of feedback on. And then the other thing I've been asked about is this new study about something called HMB and ATP for getting 20 to 25% gains in power and strength and lean muscle. So we'll talk about that in just a second. But before we do that, I want to ask you a question about succotash. Succotash. I grew up when I was a kid watching Looney Tunes cartoons and I always remember Sylvester used to say flufferin. Succotash. Fluffern. Succotash. And I never knew what succotash was. I know what succotash is now because Blue Apron, a sponsor for today's podcast, on this week's menu, they sent seared cod and summer succotash with fairy tale eggplant. I didn't even know fairytale eggplant existed, but it does. And pickled grape are the type of things that I get sent to my house as a member of Blue Apron. Basically, what they do is they send.

All the ingredients to you.

It's not like a pre cooked meal. So you don't feel like a lazy ass sitting there eating this meal that somebody dropped off for you. No, no, no. They send you the ingredients and you get to learn a ton about cooking by making it yourself. But these are healthy and delicious meals that wind up costing you like less than 10 bucks a meal. And all the ingredients are fresh. And high quality and artisanal. Artisanal, whatever that means. And they're wild. Caught. They're heirloom. Heirloom and artisanal. Two words that I throw around that I have not a clue what they mean. Anyways, you can get blue apron and you can try it out for free. How do you do that? How do you check out this week's menu and get your first two meals free? You go to blueapron.com Ben it's just like it sounds. B L U E blueapron.com Ben they.

Call it a better way to cook.

And I actually do agree. It's really cool. The other day I was traveling. As I am getting ready to do right now, I'm headed down to the ancestral health symposium. Literally in a couple hours I'm hopping on a flight to Boulder for the ancestral health symposium. Google it if you don't know what it is. And then after that I am off to Salt Lake City to compete in the Train to Hunt national championships where I'll be shooting giant foam elk and running around in the mountains with a weapon crawling under barbed wire for a couple of days. Anyways though, on my last trouble about I forgot my razor and I had to actually get one from the Holiday Inn Express. Bless your heart, Holiday Inn Express. I had to get one of their little like friend esque razors and it reminded me how much shaving sucks when you don't have a good 5 blade ergonomic flex hinge lubricating strip razor, which is what I usually shave with. It is the Cadillac of razors. I get it from this company called Harry's. And what they do is they cut out the middleman like the drugstore or the hotel front desk and they send you a razor straight to your, straight to your door or whatever it is that is on the front of your house. You go to Harry's dot com. If you go to Harry's dot com and you use code Ben at checkout, you're gonna get $5 off. And here's what I would recommend. You get their Truman, it's 15 bucks, you get the razor. Did I mention it's ergonomic and heirloom moisturizing shave cream and three of their five blade German engineered razors. So Harry's.com and then enter code BEN at checkout. And then finally, should you listen to today's episode on pooping and need something that will help you poop even more, that will literally blow out your pants if you drink the whole bottle? Get yourself some MCT oil. No, I'm just kidding. Don't drink the whole bottle. You will you, you diaper moment if you do. But there is this company called Onnit and they're making an emulsified MCT oil. I'm getting to throw around all sorts of big words today. Emulsified.

What does that mean?

It means that they've made it so you don't have to blend it with stuff like coffee and tea when you add it because it's emulsified. All that means is you just put it in there and it mixes in it. Emulsification. Emulsificates. Emulsifies every time you add it to anything. Smoothies or shakes or teas or coffee. MC2O is great. It up regulates your production of ketone bodies, which can result in enhanced cognitive performance, enhanced energy for endurance, etc. But they've got some really good flavors. They've got strawberry, coconut, vanilla, heirloom tomato. No, I'm just kidding. They don't have heirloom tomato, but you can get 10% off of it. Go to onnit.com benten that's onnit o N-N-I-T.com ben10 to get 10% off all their supplements and their functional foods. Okay, a couple other things you guys have. You guys and girls, people on Twitter.

Really?

I don't know. People in their mom's basement on Twitter. I've been getting lots of questions about Michael Phelps. You may have noticed in the Olympics.

If you're listening to this, at the.

Time of the Olympics, he had weird purple circles covering his right shoulder. And there's a bunch of other folks competing in the Olympics where you see these circles, especially on Team usa. Well, those are not giant hickeys from the Olympic Village, which I've heard is just one big wild sex party. No, they are indeed purple blotches left over from the practice of cupping. Now, I have had cupping done to me before. I've had it for low back pain. I've had it for it band friction syndrome. And what you do is you actually place a cup over a certain section of the body and that cup, which is usually like this little glass cup, is then heated. Or they'll sometimes use like a vacuum based suction. It draws the skin upwards so it creates a vacuum inside that cup over the target area of your skin. And if you remember when you were a little kid and you would like suck on a cup and make your lips like purse out, if you sucked on the cup for long enough, maybe I was the only kid who was a cup sucker. Anyways, so what happens is it pulls all that skin out. When it pulls the skin out, the idea is it will improve blood flow to different areas. There is even a form of cupping that results in bleeding. Like you cup for so long that you bleed to get a detoxification effect. They've got this really cool one called fire cupping. I've had that done to me before. And that's where they actually have a flaming cotton ball that's lit. When you light that ball and you put it inside of the cup, it creates a bunch of suction from the air cooling down and contracting. And so the idea here is there are a variety of musculoskeletal conditions, tendinitis, lack of blood flow, things like that that they'll tend to use cupping for. But what does the research say? Because we're all about the research here on the show. There was one systematic review of cupping done in June 2010. A systematic review of all the different randomized clinical trials out there. Cupping. And what that trial reported after they looked at over 921 participants on cupping for everything from hematoma and pain management and compared it to conventional drug and other care. The conclusion was there is a potential positive short term effect of cupping therapy on reducing pain intensity. So there's that if you are in pain in a certain joint, it may temporarily reduce the pain in that joint. Another clinical research, kind of like a literature review, also looked into cupping and this one was done in 2010, looked at 550 different clinical studies and what they found on that one was not only potential benefits on pain conditions, but also on. Drumroll, please. Herpes, coughing and asthma. So I'm not quite sure how the cupping for herpes actually goes. I don't know if you put it over the area where you have a herpes wart or what, but anyways there's that. There was another updated review on the efficacy of cupping therapy in 2012 in which they went through 135 different research trials on cupping. And they found kind of the same thing, that it could be effective for herpes and possibly for pain management. So there you go. If you have herpes or if a joint hurts, it turns out that cupping may actually help you. If you want to win a gold medal in the Olympics, swimming the butterfly, there may be better things to do like swim, say, or shoot illegal performance enhancing drugs into your right butt cheek if you are Russian. Because we all found out that they can do that and still Compete, but ultimately cupping, that's my take on cupping, is that I look to the literature and if something hurts and I want to fix it temporarily, or if I come down with herpes, it'd be the first place I go. And then finally, I was asked about this new supplement stack I've talked about on Twitter, Facebook, a little bit. I'll be brief here. There was a study in the Journal of Strength Conditioning research that found 20 to 25% increases over the course of 12 weeks of training. And we're talking about strength, power gain of lean muscle when people supplemented with two different components at the same time. One was called hmb, which stands for beta hydroxy beta methylbutyrate, which is, yes, a much longer word than heirloom and adenosine triphosphate, which you may know better as ATP. So HMB and ATP, they took 3 grams of HMB, they took 400 milligrams of ATP, and they had these huge breakthroughs in lean body mass and strength and power. Like, unfair stuff. This is stuff that just, like, blows creatine, fish oil, anything out of the water. So here's the deal. I talked to my friend Matt from Millennium Sports because I know that he has in his repertoire of supplements both ATP and hmb. I told him if I announced this on the podcast, could us all a discount. He said yes. And he's giving us all a 50% discount on this 1, 2 combo of HMB and ATP. I've been taking it for about a week and a half, and I feel unstoppable, especially when I'm lifting. So I would recommend you give it a go. I mean, for 50% off, you can't go wrong. Well, you can. You're still going to spend money, but it's 50% off. So how do you get it? You go to BenGreenfieldFitness.com ATP. That's BenGreenfieldFitness.comATP. and the special secret code that you use is BEN50BEN50. So BEN50BEN50 to get the HMB and the ATP. All right, let's jump into today's show with Dr. Robin Chutkan on pooping. Enjoy.

In this episode of the Ben Greenfield.

Fitness show, more importantly, you got to change what you eat. So I see a lot of people coming in who want to talk about stool transplant because they've struggled with weight and they, they can't seem to keep weight off. And, and it is very clear that this whole calorie in, calorie out thing is severely lacking in terms of explaining lots of things. If you take a map of the developing world and you look at it, even today, you see in Sub Saharan Africa and Southeast Asia, very low rates of these autoimmune kind of modern diseases, at very high rates in North America and Western Europe and so on. And part of this has to do with this hygiene hypothesis.

He's an expert in human performance and nutrition, voted America's top personal trainer and one of the globe's most influential people in health and fitness. His show provides you with everything you need to optimize physical and mental performance. He is Ben Greenfield.

Power.

Speed, mobility, balance, whatever it is for you, that's the natural movement. Get out there. When you look at all the studies done on studies that have shown the greatest efficacy.

All the information you need in one place right here, right now on the Ben Greenfield Fitness Podcast.

Hey, folks. Ben. It's Ben Greenfield. Everybody knows that I'm a fan of poop and talking about poop. And so we're going to talk about poop and a lot more today because when it comes to healing your gut or getting rid of bloat and constipation or changing your gastrointestinal bacteria, AKA your microbiome, or really any other digestive topic, My guest today, Dr. Robin Chutkan, is probably one of the smartest women and physicians on the face of the planet when it comes to this stuff. She's not only on the faculty of Georgetown University and the founder of the Digestive center for Women, but she's also written not one, not two, but three different books that focus on healing the body from the inside out, starting with the gut. And I've actually read two of her books, the Microbiome Solution and the Bloat Cure. And yes, she really does love talking about poop. Like in the microbiome solution, she gets into the tiny microbes in your gut, but also talks about little things that can help to keep you happy and healthy, like fixing things like household cleaners and air conditioning for your gut. And she talks about, like eating poop. We will talk about that today. Timing your probiotics, getting a dog to lick your face, eating dirt, and a whole host of interesting things you don't hear traditional doctors tell you about your gut. And then she's also got this other book called, called the Bloat Cure. And in that book, she looks at more of like, the science behind what happens when your belly gets bloated. And she gets into everything from not just bad Chinese food, but also things like codeine in cough syrup and dehydration and birth control pills and GMOs and all these other issues that might be causing you to have embarrassing bloating or gas or constipation or all those other issues that that many folks, including myself in the past, have dealt with but find embarrassing to talk about. She's not embarrassed to talk about them. And so we're going to talk about this stuff today. Robin, welcome to the show.

Thank you, Ben. It's always such a pleasure for me to talk poop with you. So thank you for having me back. I'm ecstatic.

Well, I have, I guess, my first question for you because I've got your microbiome solution book sitting here on my desk, and in it, you talk about how you can actually smell gut issues with your patients. I'm assuming it's not because they've crapped their pants, but there's something else that you can smell. So I'm curious about this because I have had conversations in which my face is really close to somebody else's face. And I wonder, because of this sulfurous, almost halitosis breath type of thing, if they have candida or yeast or fungus or something like that, because I can smell something just strange on their breath. What do you mean when you say that when you can smell gut issues?

You're right on the money here. So let's talk about the gut first, and then we'll talk about all the rest of the body odors, because I'm obsessed. I want to start a specialty about body odor and do some research on that. But let's talk about the gut. So when I do colonoscopy, where I take a long tube with a flexible light on the end and I insert it into the rectum and I look up people's colon, looking mostly for inflammation and polyps and cancer, a lot of the patients I see have a type of disease called ulcerative colitis, which is a type of autoimmune gut disease that causes inflammation in the colon. And I've been telling the wonderful nurses in the endoscopy suite at Georgetown, where I've been doing this for about 19 years, that I can tell whether a patient has colitis or the cystic disease Crohn's without looking. Now I actually do look when I'm doing colonoscopy. I don't do it with my eyes closed, but I've been saying for years that I can smell the inflammation. And the nurses have been saying, you're crazy. You've done one too Many colonoscopies. And then there was actually, you can, like.

Okay, so I don't want to be too crude here, but, like, when they've got their pants down and they're like, you know, naked on the colonoscopy table and you're shoving the tube up their butt, are you saying you smell it then or you smell it?

I am surely not shoving the tube up there, but I am very strategically and carefully advancing the colonoscope up the colon.

That is exactly what I meant.

So my point is that, you know, we. We detect inflammat by looking at it. So this tube has a fiber optic light source and a very sophisticated camera. And we're looking at the lining, and we're looking. And we're seeing ulcers and redness and other evidence of inflammation. And then, of course, we take biopsies, and the pathologist looks at it very carefully under the microscope and looks for inflammation, looks for white cells and so on. But my. My point is that even without looking at it, when I put the scope in, the odor is different. And what we realize now, there was a study from Japan looking at gas chromatography and basically the different gases that different bacteria produce. And they were able to identify a signature gas chromatography pattern, which basically is a kind of smell, when you sort of get right down to it, based on the different bacteria present. So in patients with Crohn's and ulcerative colitis, they have decreased microbial diversity, meaning they have fewer species and strains, and they have overrepresentation of some bacteria and underrepresentation of others. And because of this change in the microbiome, the different gases that are produced are different. And when they use this instrument, this gas chromatograph, to check the different levels of gases, they could tell, they could predict who had Crohn's and ulcerative colitis. And I could predict. Well, I mean, I've never actually done a scientific study, but the point is, when I put the scope in and, you know, the smell changes, I can smell the difference. And even. What's really interesting is even in patients, for example, who have had traveler's diarrhea, where they don't actually have inflammation that you can see with the naked eye. But I will say to the nurses, this person's colon smells off. I never like to use the word bad because that's very subjective, right? I mean, everybody thinks that their poop doesn't smell bad, but it has a very different odor. And, you know, stool, healthy stool, has One particular odor and unhealthy stool has another and the same thing. So when you put the scope up and you're essentially kind of sniffing the colon, if you will, ideally with not a lot of stool in it, if the patient has done their job and done the bowel prep, but the remnants of the stool. But I think what I'm really detecting is a bacterial signature of the stool in different people. And so it was really sort of a treat for me when I saw this article, and I kind of came racing into it, the hospital, and I'm like, look at this. This is what I've been telling you all along. So we really can. And what you smell in terms of smelling people's face and so on. The thing with BO Is just fascinating. So there are two kinds of sweat glands. And, Ben, you sweat a lot because you're always running around, standing, climbing, a rope jumping. So always.

I actually, I sweat ever since I started doing a sauna. I've actually. When people do sauna, you actually upregulate not only the number of capillaries that help you to cool, but you also get more active sweat glands. I've been doing sauna as a daily practice or near daily practice for a couple of years, and now I sweat.

Sweat even more at the drop of a hat.

It's crazy, because my sweating mechanisms are so good.

For better or worse, you're the ironman of sweat now, not just of iron man. So we have these two different kinds of glands. We have eccrine glands, which are kind of all over our body, and they release the typical sweat, which is just a little bit of salty water that when it evaporates from our skin, it helps to cool us. And then we have another kind of gland called apocrine glands, and these are kind of in our moist areas, in our hairy bits, like under our arm and in our groin. And they release when we're stressed, a milky white substance that doesn't essentially smell bad, but when it mixes with bacteria in these moist areas, gives you B.O. which is why I can go out and run eight or nine miles later today in D.C. where it's hot, and I'll come back and I will be sweaty, but I won't smell particularly bad. But if I know that I have a deadline tomorrow and I have a document that I'm working on that I'm not finished, which is often the case, and I have to stay up all night or if I'm about to do, like, a live TV appearance, and I'll get that kind of sweaty in the groin and onto the arm thing, I'll be funky. I will smell bad. I will have bo and that's because the difference between the eccrine glands, which is just water absorbing from being absorbed from your body and cooling your body down with the evaporation, versus the bacteria acting on these apocrine secretions. And it's really unbelievable how quickly that can happen. If you are in this kind of stress state, fight or flight, and your sympathetic system is firing smell under your pits, you'll notice a really big difference. So. So the whole odor thing, and that's all bacteria. I mean, funky feet is different bacteria. It's all the food we eat. So meat eaters typically smell different from people who are primarily plant based. And you can smell it, as you said, you can smell it on the skin. I see patients who have yeast overgrowth. They often. You can see the fungal growth in their ears. They kind of have a red scaly rash in their ears and sometimes on their scalp. And you can smell that, you know, if you smell it often enough.

Yeah, it's crazy, even, like, and again, like, I think our listeners now fully realize that there is a great deal of talk about stool on the show. And by the way, the show notes for today are at BenGreenfieldFitness.combloat that's BenGreenfieldFitness.com bloat for those of you who want to check out Robin's books and the other things that we talk about in today's show. One thing I've even noticed is that since I started doing things like, like sauna and I do like a metal detox every year, and I don't really eat processed and commercial foods at the risk of sounding orthorexic really almost at all anymore. But not only does my sweat not seem to stink much at all unless I'm stressed out like you just talked about, if it's more like a sympathetic fight and flight type of sweat. But I also have noticed that the bathroom smells different after I finish taking a dump. It smells like.

Vegetables almost. That's the best way I can describe it versus this intense, nasty, sulfurous smell.

That you get when you walk into.

Say, the bathroom at an airport where there's a whole bunch of people just pooping toxic crap.

Exactly. That they've been eating at the airport.

Yeah, exactly. So you get into, obviously, how to fix some of those colonic bacterial issues in your book, but you also get into some other really interesting things, some things that we haven't talked about on the show before. For example, one thing is you mentioned both pig whipworms and also hookworms in your book. What the heck do those have to do with your gut and maintaining a healthy gut?

So there's something called a hygiene hypothesis, Ben, which actually refers to the fact that as countries get more industrialized and more developed, we see higher rates of autoimmune type diseases like Ms. And asthma and allergies and Crohn's and ulcerative colitis and so on. And if you take a map of the developing world and you look at it even today, you see in sub Saharan Africa and Southeast Asia, very low rates of these autoimmune kind of modern diseases and very high rates in North America and Western Europe and so on. And part of this has to do with this hygiene hypothesis, which was described in post industrial London in the 1950s, where they were seeing skyrocketing rates of eczema and hay fever in kids when everybody had left the farm for the factory. And it refers to the fact that as we become cleaner and too clean, one could argue we kill off all these important sort of founding germs, if you will, that are important for training our immune system so that our immune system doesn't overreact to bacteria, which is really what autoimmune diseases are, is an overreaction of the immune system. And so the hygiene hypothesis says that we need exposure to dirt and germs and common illnesses, in fact, to develop our immune system. So if we think about our ancestors, they were probably completely infested with parasites, helminths, you know, different kinds of worms and so on, and their immune system peacefully coexisted. And in fact, this infestation kind of kept their immune system from overreacting. And so researchers in the past couple decades actually have looked at, particularly in Crohn's disease, which again, is this autoimmune gut disease, different ways to dampen down the immune system without the risk of infection that drugs that dampen the immune system, like steroids and other immune suppressing drugs do. Those drugs can work great for diseases like Crohn's, but unfortunately they can also cause severe infection and cancer and other not so great things. So they looked at this novel type of therapy of inoculating people with parasite, with the theory being that if you can, if you can cause just a limited kind of controlled infection with a fairly benign helminth worm, you can restore the body's autoimmune system to a more balanced state and make it less overreactive. Now, hookworm therapy is problematic because hookworms can be symptomatic. They can cause anemia and itching and diarrhea, and the infection can sort of get out of control. So the initial studies were done with hookworm, but they've also looked at using pig whipworm. The advantage of that is that the whipworms cannot multiply inside the human host. So you give a small inoculum, you see how people do, and then once you think they've died off, you give some more, as opposed to the hookworm, which can reproduce within the body. And there have been some good trials. One trial with about 50 people with ulcerative colitis, they looked at giving, you know, sort of readministering the eggs every few weeks. And after six months of therapy, 80% of the patients had significantly reduced disease activity, and almost three quarters of them had gone into complete remission. So, again, I don't want to suggest to people that they go out and they infect themselves, but from a theoretical point of view, this is fascinating, and we're not quite there. I am not using hookworm or whipworm or pig whipworm therapy in my office. I'm doing mostly nutritional therapy for these diseases. But we are definitely onto something here with this idea that we have become too clean. And we need, in order to restore our immune system, our microbiome, our overall body, into a more balanced state of health, we need to really rethink our relationship with nature and with bacteria and viruses and worms and all these other things. And this sort of mischaracterization of all germs as being bad has made us pretty sick.

Yeah, that's fascinating. And when it comes to hookworms and pig wickworms, correct me if I'm wrong here, but the idea here is if you have gut inflammation or some kind of. We've talked about autoimmune issues on the show before. People who perhaps are really sensitive to wheat or milk or eggs or something like that, they've been eating them for long periods of time. So they've got gut infection or not really infection, but more like, you know, inflammation or leaky gut or something like that. When you. When you eat the eggs of a. Of a pig whipworm or a hookworm or something like that, what you're essentially doing is shutting down that inflammatory response by triggering some kind of an immune response against that whipworm or that hookworm.

Yeah. You know, what it is, is that when your body is dealing with chronic, let's not say infection, but say coexistence with a whipworm or a hookworm, it realizes after a while, like, okay, I don't have to sort of mount a big reaction to this. There's this worm living with me and we're gonna figure out a way to get along kind of peaceful coexistence. And so I'm not gonna freak out. And so the idea is then it dampens the immune system down so that it doesn't freak out in other ways. So with diseases like Crohn's, which mostly involve an overreaction to the body's own gut flora, the body's own bacteria, that it will take that same kind of chill attitude and say, oh, and I'm not going to overreact to the bacteria in the gut either, and cause ulceration and strictures and bleeding. So it kind of dampens down the immune system in general, but not in a pharmaceutical way where then your risk for overwhelming infection increases.

That's interesting. So for something like pig whipworm therapy, for somebody who has severe gut issues or, or an autoimmune disease or something like that, because the eggs can't multiply, this is just like a treatment that you take every few weeks.

Exactly. As a can multiply, and then you could actually end up with quite severe hookworm infection if you're not careful. But this idea too, going back to early childhood, so we've always been a little bit into the benign neglect form of parenting, where we don't get too disturbed if, like when our daughter's 11, but if she ate something off the floor, it was like, okay, that's fine. It doesn't look hideously dirty. And it turns out that is actually a really important thing. And this whole hygiene hypothesis, when David Straughn, who was this professor of tropical medicine at the London School of Hygiene, was tasked with figuring out why they were seeing these skyrocketing rates of eczema and hay fever in post industrial London. He made two really important observations that form the background, the backbone for the hygiene hypothesis. The first is that kids who came from large families had very low rates of hay fever and eczema. Why? Because they had had a ton of siblings who were sneezing on them, coughing on them, giving them measles, mumps, whatever, making them sick. And those, those illnesses which were kind of, you know, low risk illnesses that weren't things people were dying from, were strengthening their immune system. And the other startling observation was that kids who came from affluent families that had higher levels of hygiene. I mean, again, this is like 1950s in London. So they. It's typically like a household of 10 people with one bathroom. So people who are in more affluent households who had better access to more hygienic practices had higher rates of hay fever and eczema. So it was good to have lots of siblings and it was good to be relatively poor in terms of your immune system back then. And we still see these trends today. And so we still see that kids who. These kids have higher rates of allergies and asthma. Right.

Yeah. It's something that we've certainly talked about a little bit on the show before and that you touch on in the book. Like everything from getting out and gardening and even licking the dirt off your hands, which sounds nasty, but there's actually something to it, to letting your dog lick your face and not being afraid of the germs that you might get exposed to from your pet. And even me, honestly, Robin.

I used to be a little bit of a germ freak, especially when I would travel and I would do things like really high dose, like oil of oregano and thieves essential oil and all these different things when I was in crowded places and buses and airports. And then I quit doing that for a little while just to test this idea that perhaps I do just need to make sure that I get exposed to a wide variety of germs and bacteria. And frankly, unless there's some kind of issue going around like bird flu or unless I. Yeah. Or swine flu or unless I know that I am literally sitting next to a kid that has the sniffles who's just coughing all over the place, I've been a little more reticent to be so much of a germ freak. I still, of course, wash my hands when I go to the bathroom at an airport or something like that. But, yeah, it's been less and less of a concern for me these days. But you also get into. In your book, you kind of go above and beyond just pig workworms and hookworms, and you talk about this Bedouin tribe that actually eats camel feces. And you also point out about how we have all these other animals in nature that will eat each other's and other animals stool. I'm curious, what does this have to do with the gut in terms of something like a Bedouin tribe eating camel feces. Because I was always under the impression.

That.

You really increase your risk of getting exposed to things like. Like giardia or amoeba or nasty things when you're eating the poop of some other creature. So can you kind of delve into this for us.

I sure can. So let's be clear, though. You're only as healthy as a stool you're eating. But I'll just start it off with that. So this concept of coprophagia, of eating stool is not new.

What did you call it?

Coprophagia.

Coprophagia. Right. So we think of it more with, like, you know, there's different forms of. I don't know how to put this diplomatically, but there's a term for it called scat sex, scatological sex that involves different sex acts that involve eating stools. So I'm not talking about that or I'm not talking about people who are mentally ill and sometimes ingest stool. I'm talking about this from a more sort of medical point of view.

We'll save the kinky stuff for another show.

We'll save that for another show. I'm not sure I'm quite qualified to be on that show, I'm happy to say. But we've known historically that Bedouin tribes would eat camel feces when they have dysentery. So when they get a very bad diarrhea and vomiting and clearly have something infectious, that they would eat small amounts of camel feces from healthy camels. And that's to reintroduce healthy gut bacteria. And veterinarians have done this for decades that if there is a diarrheal type illness in the herd, they'll take stool from a healthy cow and they'll give it to the other cows to eat. And it's basically just sort of nature's probiotic. Right. So when we're talking about cows eating other cow poop or the Bedouin eating a little bit of camel feces from animals that have been under their control and that they're very aware of their health, that's different from people just going and sort of randomly having someone stool. But we're in this era of FMT fecal microbiota. Transplantation is a technical term, and it has turned out to be this unbelievable cure for a very difficult problem that we're seeing with a rising incidence in the United States. And that's clostridium difficile infection. So clostridium difficile, or C. Diff, as we like to call it, is a very hardy bacteria that a lot of us are colonized with at birth. If you're born in a hospital, 3, 4% of us are colonized with it. But people get it after taking antibiotics because the antibiotics kill off. So Much of the healthy bacteria that small levels of C. Diff can proliferate, or if you've been on antibiotic recently and then been in a hospital setting where there's plenty of C. Diff, the C. Diff now proliferates out of control because all of the healthy kind of gatekeeper bacteria that would normally keep things suppressed are not around. The C. Diff proliferates and it's been very resistant to antibiotics. So a few years ago, about four or five years ago now, the article was published in the New England Journal of Medicine, our sort of gold standard medical journal, about FMT fecal transplant as an alternative to antibiotic therapy. And in fact, in the seminal study, the FMT was so successful they had to stop the study. They said, ethically, we can't even continue to use antibiotics for these refractory cases, not as first line therapy, but in people with refractory C. Diff. And C. Diff kills about 15 or 20,000 people in the US every year. I mean, it's.

How do you know if you have it? How do you know if you have the C. Diff?

Well, if you are having what we call a pea soup diarrhea, watery, severe diarrhea, and you've been on antibiotics recently, like in the last month or two before it developed, it is absolutely essential that you get a stool test for C. Diff. There's a toxin that it makes and the stool test is very, very easy to do and all the commercial labs do it.

Would this be like a poop panel, like the three day gut test where you're just like pooping a. In a hot dog tray for a few days?

It's a little bit different. No, it's just a one time specimen actually that you can send. I mean, if we have a high index of suspicion, we actually like to get three samples because the sensitivity really increases with three samples. But it's just a small specimen and they run it in the lab and they run it pretty quickly. They can get the result back in 24 hours. The C. Diff toxin, once we identify that. So the mainstay of therapy for C. Diff had been antibiotics, primarily one called ciprofloxacin. Sorry, not ciprofloxacin, one called metronidazole and another one called vancomycin. But when you think about it, what causes C. Diff? C. Diff is caused by antibiotic use. So it kind of makes sense that giving more antibiotics is not necessarily the best way to treat it. And that's exactly what we've seen. We've seen a ton of refractory C Diff and not responsive to those antibiotics. So FMT is something that people started using and it is now the gold standard for refractory C Diff. But as you can imagine, Ben, there are lots of problems with ingesting. It's usually done at colonoscopy, given through the rectum. We can do it as capsules that people ingest. We can drop a NG tube, a nasogastric tube down into the stomach and give the stool that way. There are lots of ways to do it.

And you're obviously not using that person's own stool. You're using the stool from someone else.

From a healthy person, either a healthy relative or friend sort of intimate contact is ideal. Or there are stool banks now there's one called Open Biome, based in Boston where they provide. They do very extensive testing and screening of the stool. And they have robust donors who have healthy stool. And we get frozen stool from them and we thaw it out and we use it. And so a lot of hospitals we use OpenBiome at Georgetown are doing that if somebody doesn't have a good donor. Because as you pointed out when we started talking about this, it's not all fun and games in terms of stool transplant, because stool is also waste matter and it contains toxins and it can contain infectious things. So we have to test for syphilis and HIV and hepatitis and a lot of things on the donor stool. And you're getting not just the good healthy microbes from the stool, you're also potentially getting DNA from not so good microbes and viruses and any infectious things. And there's a lot we can take test for. And in my book, I have a whole, a whole section on everything you wanted to know about stool transplants. But we're free to ask, including all the testing that we do. And it's a lot, but there are also lots of things that we can't test for because we don't know about them yet and we don't know how to test for them. And so, you know, the things that can be spread through stool, you can spread C. Diff, you can spread crypto, E. Coli, giardia, as you mentioned, hepatitis, norovirus, poliomyelitis, rotavirus, shigella, taperums, typhoid fever, vibrio, lots of things. But that list, the real list, is probably three or four times as long with the things that we haven't even discovered yet and we can't test for. And So a couple things with stool transplant, like, you have to make sure if you're doing it, you're getting it done for something where there's actually been a clinical trial showing it works so that there's some risk benefit calculation that's gone on. So if you have refractory C. Diff and you've been treated with a couple rounds of antibiotics and you're not better, you're probably a great candidate for fecal transplant. And probably just one stool transplant is going to fix your problem.

Wow.

If you have a condition like Crohn's or ulcerative colitis or some forms of irritable bowel syndrome, there are some clinical trials, but you should be doing this in the setting of a clinical trial where they're actually looking at these parameters and so on. And again, there's a lot of other optimism and there's a lot of hopeful data. But it's important for people to remember that for some of these autoimmune diseases, it's not a one shot deal like the C. Diff. You have to probably be doing a stool transplant a couple times a week for several months, maybe even years, maybe even lifelong, trying to reverse the damage. So those are situations where you're dealing with much more microbial discord than just overgrowth of one, you know, troublesome bacteria. You're dealing with people who have a genetic predisposition for these diseases and have significant changes in their microbiome that you're trying to undo. I spend more time in my office talking people out of stool transplants than convincing them that they need one. Because people feel like, oh, this is a panacea. Right. I have microbial discord and that's why I'm fatigued and my hair is falling out and I'm bloated and I don't feel good. And it may be, but we don't have evidence that doing a stool transplant is going to fix those things.

Things, Right, Right. So this would be not for people who just like, have a tummy ache or who are constipated every once in a while. This would be for someone who has like C. Difficile. They've been tested, they get diarrhea a lot. So not. What about like irritable bowel syndrome? Irritable bowel, where you just like really touchy gut. You have gut issues. Is this something that is worth, I guess, trying, or would this really be like last resort, my butt is exploding with diarrhea type of thing?

Again, there's a lot of really Interesting data that show for people who have what we call diarrhea predominant ibs, ibs D that in a lot of those people there is some infectious antecedent event that kind of creates the damage. And so there are studies that show in a subset of these people with IBS.

They actually can have significant improvement. But again, it really needs to be in this setting of a study where they're looking at your disease and they're seeing if you're in this diarrhea predominant subtype and you meet the criteria and so on. And the results are definitely not as dramatic as for C. Diff. There is a small study from New York from Montefiore Medical center, and I think the FMT resolved or improved symptoms in about 70% of patients with refractory IBS and improved quality of life in almost. But again, you have to carefully exclude. You want to make sure that your IBS is not because you're gluten sensitive and didn't realize it or you're lactose intolerant. You know, that's why it's so important to do this in a center where they're going to carefully exclude other causes and not just say, sure, I can stick some stool up there for you. I mean, unfortunately, there are lots of clinics that do that. They charge a ton and they're treating.

Many, many different groups of patients, some who probably have a clear indication, but many who don't and are just kind of desperate. And we all know, I mean, we've all been there probably in one form or another, where you're desperate about something and you literally are willing to try anything. After I had my daughter, she's 11 and a half now, I had a lot of hair loss, sort of typical, what they call, you know, the postpartum hair loss effluvision that develops. And I was desperate, and I was, you know, trolling the aisles of the health food store late at night looking for some miracle thing. And I remember my husband saying to me, who's bald and shaves his head? He was like, honey, if that stuff worked, I'd have an afro, right? So I think you just have to give it a little bit of time. But I understand. I mean, even with a medical background, I was still like, oh, if I take enough biotin and, you know, iron and whatever, maybe I can make this come back. And hormonally, things kind of settle down. And it was all fine. But I completely understand. And there's so much we don't know in medicine. So there's just conventional medicine is lacking in so many ways. And so it's very, very kind of intoxicating to think about the idea that, gosh, my microbiome, I took a lot of antibiotics when I was young. I've been on steroids or acid suppressing drugs or NSAIDs or other things that mess with my microbiome. And that's probably why my hair is thinning and I'm bloated and I feel tired. And again, that may all be the case, but what we have to the flip side of that is ingesting your friend stool, your husband stool, your girlfriend's stool, is that going to make you better? We don't know. I mean, most people who were born and raised in America have probably kind of had similar experiences with being over medicated and undernourished. And so what I would say to most people is, you know, if you're going to do that, you should be getting stool from the tribe in Tanzania or some of our Amazonian brothers and sisters, where people. Because if you're ingesting someone's stool who's been taking antibiotics and eating crappy food, it's not going to do you much good.

Yeah, you want the stool of someone who poops like a baby. Now that actually leads me to two other quick questions I have for you about fecal transplants. And I promise for those of you listening in, we aren't going to talk about eating poop the whole time. But you talked about getting the poop of a Hasda hunter gathering gather tribe put in you. One of my buddies, Jeff Leach, he actually did that and he hung himself upside down.

He's terrific. I follow him. He's fantastic. Yeah, yeah.

But my question about that is, does it change? Like, we all know that the gut helps to create neurotransmitters. It has a great deal to do with, you know, like, if you don't have enough good bacteria, you can get depressed. They've shown that probiotics can now be used as a antidepressant treatment. But my question is, if you get a poop transplant, or have you seen this in your clinic, do people's personalities change? You take on any of the characteristics of the person whose poop has been transplanted into your. Like, if you get a Hasda injected, you become like a mighty warrior. What happens?

Well, most of the experience we have is in people who are getting one stool transplant for C. Diff. So things are not changing dramatically. But we did have a patient who received a donor stool from her daughter who was obese and she started to gain weight. And that's something we can chat about in a minute. But just to get back to how things change, you know, we, we think that stool from again hunter gatherers that haven't been eating at McDonald's and taking antibiotics is better and it probably is, but there's also adaptation. So you want stool that's adapted for your particular environment. We know that there are these different enterotypes in, in terms of how we classify the ecosystem and the gut. And it's a way we kind of stratify people based on the representation of different species. So about.

Gosh, about five or six years ago we came up with this classification of different enter types. So type one has high levels of family of bacteria called Bacteroidetes and then type 2 has low bacteroides but lots of prevotella. And type 3 has high levels of Rheumatococcus. These different families and different enter types don't seem to be influenced much by age, gender, where you come from, but they are very much affected by long term diet. So if you are one entertype in North America and you're getting stool from another entertype from somebody in sub Saharan Africa, you're probably not going to see long lasting change in your microbiome because your microbiome is more defined by what you've been eating your whole life than by this wand, you know, sort of introduction of stool. So it's not enough. And then this gets back to the issue of for autoimmune diseases where we're really trying to create meaningful change. It's gotta be on a regular basis and more importantly you gotta change what you eat. So I see a lot of people coming in who want to talk about stool transplant because they've struggled with weight and they can't seem to keep weight off. And it is very clear that this whole calorie in, calorie out thing just, you know, is, is severely lacking in terms of explaining lots of things. So I see Ben, I'm sure you do too, who are eating a very calorie restricted diet and are not losing weight. So it's more than just the calories in the food and it's more than even the percent of protein, fat, carbohydrate. Different people metabolize food differently and we know that a lot of that is a microbiome. So microbes can actually, they can do unbelievable things in the gut bin. They can change the taste buds, they can make certain foods taste better, like sweet versus savory, they can affect the transit time so they can speed up the transit time through the gut so fewer calories are absorbed or they can slow it down. They can themselves ingest and digest extra calories so that fewer are stored by fat. So microbes can really change what we call the energy harvest of food. And we see it all the time where, you know, people are very calorie restricted, they're still not losing weight. Other people eat a ton of food, they don't exercise that much, they don't seem to have much as much problems. We know there's one particular bacteria called Kristen senilesia. You can say it three times fast. And that Kristen senilesia seem to be associated with leanness. And there seems to be a genetic inheritance pattern. And we've all seen families where like, everybody's a string bean, right? These families were like, it's all ectoderm and they just never. Everybody's tall and skinny like a bean pole and never gains weight. And so there are some of these genetic tendencies. So there have been some really fascinating studies where they've taken microbes from obese mice and transplanted them to germ free mice. And the germ free mice start to gain weight without any change in the diet. And they've even done it from humans to mice. Researchers at Wash U took identical twins where one was lean and the other was obese. Same genetic material transplanted the microbes into germ free mice and lo and behold, the mouse who received the microbes from the obese twins and gained weight without any change in diet. So we know even across species this occurs. But at the end of the day, it's still about what you eat, because I can give you billions of microbes from somebody really lean. Unless you're eating the right diet to nourish those microbes. They're not going to recolonize, they're not going to repopulate your gut, and they're not going to have a lasting effect on your microbiome. So this idea that all the pharmaceutical companies are kind of racing to come up with a microbial cure for obesity, there are probably different microbial strains, probiotics that people will be able to ingest that will help. But at the end of the day, it still boils down to you got to eat more vegetables because there's nothing you can take. And then you can eat Doritos and drink soda and lose weight. That just doesn't exist.

Dirty vegetables, especially dirty vegetables, that's my big thing. I like to eat them dirty. If I can get them from a garden and not wash them.

Yup.

Obviously, if you're buying your vegetables non organic from the grocery store, freaking wash them. So you're not getting glyphosates and herbicides and pesticides into your system. But yeah, vegetables plus dirt is a pretty good scenario for people's gut. One last thing on poop pills. And then I want to talk about constipation a little bit. Poop pills, from what I understand based on the most recent news, do not work compared to the actual, I guess you would call it the poop up the butt type of scenario. Like the fecal transplant. It looks like there are a couple pharmaceutical companies trying to develop a drug. I know buzzfeed just had an article about this and they spent all this money developing these microbial transplant stool sample pills. And apparently it didn't really show much efficacy at all in this study on oral consumption of a poop pill. Do you know anything about that?

I do. So there are two different things we can talk about here. One is actually a Canadian study, took stool from a healthy donor and encapsulated. And it was about 37 different pills you had to swallow of actual stool. And that study and a couple others like them that have taken actual stool and just put it in, you know, like a little liner to protect it from the acid in the stomach and have you swallow them. Those work. And those seem to work as well as stool up the butt. If it's actual stool you're talking about is probably Ceres, the company that had these spores that they were using, these bacterial spores that you would ingest for CD Diff. Yeah. And they just. Their data was. Was very surprising to all of us because our preliminary data was very promising. They did not work.

For the C. Diff. And they're, you know, they're kind of going back to the drawing board. But that's different because that wasn't actual stool. Those were spores, those bacterial spores. Because nobody, you know, ingesting someone else's stool, even, you know, my husband, I love him. I still don't want to eat a stool. You know, it's still not. It's sort of.

So they're really looking at different things they can do. So for example, could they take like Ben, could they take. If you got C. Diff, could they take your stool and pull out the healthy strains and amplify them outside of your body and then give them back to you? Sounds like a great idea. Right. Because it's your own stool. But just taking out the good stuff and really amplifying it. Can they do that? Could they take again, just the spores? Could they take healthy bacteria and amplify them without all the other yuck stuff from the stool? Haven't really been able to do that well yet. But that's. That's definitely the goal is to be able to not give the whole stool for a couple reasons. The yuck factor as well as the fact that you're transmitting toxins with the stool too.

Potentially interesting. Okay, so don't go route if you're listening in, don't go rush out and buy poop pills because they haven't really been shown work.

Gogo get some dirty vegetables because those actually vegetables.

All right, let's talk constipation. I think we've kicked the FMT thing to death at least a little bit. But you have an entire chapter in your book, the microbiome solution that actually goes into, like you mentioned everything you always wanted to know but were afraid to ask about fecal microbiota transplants. Okay, so how about this constipation? I know a lot of people have constipation because I get questions about it all the time. I don't know know if it's because a lot of active people listening to the show who eat copious amounts of food and who are also type A personalities. I don't know if it's because of some of the issues that you talk about in Bloat Cure, but there were a few things that I kind of folded over as far as pages in the Bloat Cure and possible causes of Constipation that I hadn't seen talked about too much. One was musculoskeletal imbalances like pelvic floor disorders and something called anismus. And the reason that I wanted to ask you about this was because I have noticed that if I am competing, lifting, et cetera, for long periods of time without deep tissue work and specifically without doing things like I'll take yoga, tune up balls and roll my butt cheeks, all those tight areas in the butt cheeks around on the yoga tuna balls. And I will use. I have this car buffer type of massage device that kind of like, like rumbles just like a vibrator. And I'll work the front of my abs in that like areas, deep tissue areas in my abs that just like any other area of the body, if I'm doing a bunch of abdominal work, tend to get really tight and adhesed. And you talk in your book about pelvic floor disorders and musculoskeletal issues related to constipation. I found that if I let all that stuff get tight, I don't poop well, even if I'm eating a really healthy diet. So can you get into this idea behind what you call. Do you pronounce it anism?

An isthmus? Yeah. So constipation is actually one of my favorite things to treat because we have a very high success rate. And this is where I get to be a little bit of a medical detective and roll my sleeves up and start snooping around. So, anismus. Remember that the GI tract is just one long muscle, and it's not that different from your biceps or your hamstring or any other large muscle in the body. It's got some specialized features to it. But if you're not moving, neither are your bowels, because you kind of have to work them out. And that doesn't necessarily mean doing an ironman. It could be walking around the bl. It could be. I'm standing as I talk to you now, because I know you're a standing man. And so if you're really sedentary and you're sitting for long periods of time, your chances are you're gonna have sluggish bowels. And the most sluggish bowels we see are people who are in nursing homes who are literally lying on their backs for, you know, 22, 23 hours a day. But when you think about it, sitting is definitely the new smoking. And many of us who are younger and not nursing home candidates are having that experience. We're sitting in chairs and doing nothing for hours and hours during the day. And then we're kind of jumping up and like, oh, let's go to soul cycle for 45 minutes. And unfortunately, that's not enough. A lot of the time, it's really that sort of daily, hourly. What are you doing? So, number one, it's a muscle, and it needs to be exercised. We talk a little more specifically about anismus. Anismus refers to essentially when you sit down or squat or however you're having your bowel move, movement to try and push the stool out. There's a muscle that has to open. This puborectalis muscle angle has to change to allow the stool to clump.

We've talked about that before when we've talked about squatting to poop. And the squatty potty.

Yes, Love the squatty potty. Or I'm pretty bendy. I like to both. So I just put my heels up on the toilet seat and Every now and again I tip over. But fortunately that doesn't happen too often.

That's what I do when I'm traveling, actually, because I do not travel with a fold up, squatty body.

You don't, you don't have it in your backpack.

I don't think they make one.

Shame on you. So with anismus, what happens is that that angle doesn't open to allow the stool to come out. And there are a number of reasons why that can happen. In women, it's often something that happens from the time they're young girls. Girls in general tend to be more fastidious about the bathroom facilities. So girls, I mean, this is a huge generalization, but girls in school will be like, oh, there was a gap in the door and somebody could through or people cut hair or it was dirty. And you know, we tend to become more aware of our surroundings, like bathroom surroundings and so on, and be more embarrassed by that at a younger age than boys. So girls often develop this whole concept of shy bowel where, oh, they don't use a bathroom at school, they have to wait till they get home, or if they're traveling, they don't want to go in an airport. Can happen to men too, obviously. But what that does is it totally confuses your bowels. So now you get that urge to go. The stool is all lined up in the rectal, all ready to come out. And instead of you sitting down and opening up that angle by the muscle, relaxing, instead you're squeezing and you're again confusing the bowels. And they're like, oh, well, I thought I was supposed to open. I guess I'm supposed to close and hold it in. And if you've ever had that experience where you have to go and then you're like, I'm gonna, I don't know, I'm gonna go do something and come back. Often it's gone right, you're done for the day, it's just not coming back. And it's because you've confused the bowels. So it's so important. There's such exquisite feedback with the enteric nervous system, the nervous system in the gut and your brain. And so you have to be so careful that you're not on training your bowels. And that's what happens to so many people. Like, oh, I'm not going to use a bathroom at school, I'm not going to have a bowel movement at work, I'm not going to go on the train, which can be challenging. And then, you know, lo and behold, when you're finally ready, your bowel is like, oh, oh, no. You told me to hold it, so I'm holding it. I'm not letting it it go. And so we have to think about that too. With an isthmus and woman, as a pelvic floor descends as it, you know, everything kind of eventually descends and gravity takes over. But particularly, you know, if you've had kids, there's something called a rectocele, which can be a big bulge between the sort of GI tract and the vaginal vault, and stool can get stuck in there. Sometimes women have to kind of put a finger in the perineum, in that space between the vagina and the rectum to press on things, to get that pouch to empty. The muscles can. The whole relationship between the muscles changes. So pelvic floor problems, enzymas, which can develop from holding in kids. What can happen a lot is, let's say you're out your kids at summer camp, and they're not drinking enough water, and they're not eating lots of fruits and vegetables. They get a little constipated. Then they find that when they finally push a stool out, they may get a fissure, a little tear in the lining because the stool is really hard. And then because of that fissure, every time they go, they have pain. So what do they do? They start holding. And, you know, we have kids coming through all the time in the emergency room who are impacted. They are literally full of stool because they got a little fissure. It got painful. And then they were like, oh, I'm not pushing this out. This hurts too much. And it happens with adults, too. So it's so important to really have a dialogue with your bowels and to make sure that you're doing all the right things. I mean, the things we know about, like fiber and water, but also the movement, not holding it, heeding that signal when it comes. Super important.

Now, one of the other things that you talk about when it comes to constipation is this idea of dysmotility, which I guess is like a sluggish bowel. Is that pretty common? And if so, are there things that you can do? Like, I've heard of prokinetics, for example, like special capsules that have ginger and stuff in them that speed up the bowel function. Is that how you fix something like this? Or what's the deal with colonic dysmotility?

So colonic dysmotility is very much a real phenomena, and unfortunately, the cause is often found in the medicine cabinet. So antidepressants, narcotics are number one on the list. So pain medications definitely slow down the bowel. And I mean so much so that there's a whole term for it now, opioid induced constipation. And unfortunately a drug for it instead of like, oh, that would be stuff.

Like Valium or Ambien or stuff like that.

Well, it would be more things like Percocet and Demerol and things like that. So opiate containing narcotics which are so over prescribed in the US and you know, people, there are people who have real pain and who need real drugs. But so often it's somebody's gone in with something minor, a little muscle ache, and then we end up prescribing them a serious narcotic. And not only does that potentially lead to problems with addiction and dependence, but it leads to serious bowel problems because it slows the bowel down. So we see lots of people who are, who are really constipated because of pain medication.

So it's not just, it's not supplements that would make you tired or medications that would make you tired, it's specifically opiates or opioids.

Well, those are the, probably the most egregious in terms of having the most significant effect on the bowel. But lots of over the counter medications can do it too. They can dry you out. So antihistamines can do it, antihypertensive medications can do it. Calculated calcium can do it, iron supplements can do it. There's so many things that can cause some minor constipation and then if you add to that a little bit of dehydration, a little bit of inactivity can lead to more severe dysmotility. But I really recommend the first thing you do is you look in your medicine cabinet and you really investigate the effects on the bowel of drugs that you're taking, prescription drugs, over the counter drugs, supplements that you're taking, number one. And then, then there are prescription prokinetic drugs on the market, but they're not great. Most of them cross a blood brain barrier and have neurological side effects. So you're kind of swapping one problem for another, not so good. Or they have other issues. There's one that can cause prolactin release and can cause you to start releasing milk from your nipples. Not so great if you're not nursing. So they all have potential side effects that can be problematic. There are some natural things that you mentioned that can happen, help. But again, water movement, more fiber, natural kind of pro motility things that you can do. And abdominal massage can help a lot. In my first book, Gut Bliss, I have this whole section on happy abs of how you can use a light weight or even just your fist and move it in a clockwise direction, kind of circumnavigating your belly button to kind of help move the products of digestion through your GI tract. Twisting yoga poses are great.

I swear by that. It's really interesting you bring that stuff up because I actually have a special morning routine where I'll do some torso twists and what are called these core foundation poses, which actually kind of elongate a lot of the organs in the gut. And then I do that massage on the abdominals. I have a whole system down. I know we're getting close to the end of the podcast and so I wanted to rapid fire a few questions at your you regarding the gut and some of the other things you talk about in the book. So we might go with faster answers to these questions as we delve into rapid fire. But here is. I'll give you a quick overview of what I do to poop like a baby and you tell me what you think of this.

If you're good.

Okay.

So the night before, I always take a little bit of magnesium in water, but then I do like a. I don't know if this would be considered a prokinetic or what, but I do a blend of turkey, rhubarb root and slippery elm bark and marshmallow root, fennel seed, fenugreek. It's this stuff called nature Cleanse. I do that with a big glass of water and some magnesium. And that's the night before.

Love it. Magnesium is a really great gentle helper for constipation, so. Love it.

Yeah, magnesium seems to help, but when I combine it with this nature cleanse stuff, it's like a potent one, two combo. And then what I'll do is I get up and the morning and I'll have another big glass of water and I have a cup of coffee and I do those foundation poses to decompress the spine and open up the organs. And then I finish with that colonic massage, or not colonic massage, but that left to right massage, right. For about five minutes, then again the squatty potty and everything just falls out.

I love it.

Good protocol, bad protocol. Am I missing anything?

Great protocol, but I think the part that you should mention is that you also eat a diet with lots of plants.

I do.

That's great. So that is not gonna work so well if it's you know, Doritos and soda all day long. I mean, a little bit. You'll squeeze out a small, hard western stool.

And then, as we know from earlier, it's still gonna stink like hell.

But.

It'S not gonna smell off.

Okay. All right, so my Ben Greenfield pooping routine is. Robin check in approved.

Come and hang a shingle with me. I could use your help, actually.

Okay, cool. Number two, Alcohol. Good or bad? Especially like a nightly glass of wine, which I know a lot of people, including myself, do.

Good or bad for the microbiome, in moderation, neutral. So alcohol is metabolized to acetaldehyde, which is kind of a first or second cousin of formaldehyde. It's a toxin in significant amounts. But you can get away with a glass of wine. Most people can. It kind of depends on what else is going on, what kind of shape your liver is in, what the rest of your diet. Diet looks like. But for most people, a glass of wine can be neutral. It's when you get into higher amounts or again, if you have any of these underlying problems. But remember that before there was penicillin, what was our main antiseptic? It was alcohol. Right? That's what they used to clean the operating rooms and wipe stuff down. Even now, when you go to get your blood drawn, that's an alcohol swab that they use to clean the skin. So alcohol does kill microbes in concentrated amounts. Amounts and in various forms. So you do have to watch the intake.

I know. It also increases gut permeability. So being super stressed out at the end of the day when your gut permeability is already going to go up from that, and then maybe doing a hard exercise session to blow off some steam and then having some alcohol to wind down, I know that that's actually pretty bad for the gut. So using alcohol if you're already stressed. I know. Can increase gut permeability, is that correct?

That's true. And actually, what you said about intense exercise, you know, we do this intestinal permeability testing in our practice where we use a small sugar and a large sugar, mix them together, and we measured in the urine. And intense exercise can definitely increase intestinal permeability. So as you mentioned, the order in which you do things is really important here.

That's why so many athletes have leaky guts. So at the end of a hard day like that, smoke a joint, don't.

Drink a glass of alcohol.

Okay, so a few other rapid fire questions. Probiotics and antibiotics. A lot of people take probiotics when they're taking antibiotics to make sure that they just don't completely lose all their gut bacteria. You talk a little bit in your book though, about how the timing of this strategy is important. Can you get into that a little bit?

The timing is important, but it's also magical thinking to believe that a probiotic is completely mitigating the damage an antibiotic is doing. Five days of a typical broad spectrum antibiotic will remove a third of your guide gut bacteria. And it can take years to come back. And when it does, it typically comes back in a very patchy way. You're going to be missing microbes. There is no probiotic on the planet, not now, not in the future, that is going to change that. So you have to embrace the fact that you are doing damage to your microbiome that cannot be reversed with a probiotic. And so my first piece of advice is be very judicious in taking the antibiotics. Make sure that there is no other way you can fix this problem on other than with an antibiotic. And then when you are taking a probiotic, make sure it's the most robust one you can get your hands on, that it has enough colony forming units that it has the right strains, that it has a right mix, because the bacterial kind of competing for the same resources. Make sure that the viability of the strains has been verified. But understand that this is not somehow like, oh, I took an antibiotic and a pop up probiotic and all as well. In the book I describe, an antibiotic is taking a bathtub full of water and draining out all the water and then taking a probiotic is pouring a cup full of water back in. And that's probably about right in terms of the equation. So strict avoidance of antibiotics unless absolutely necessary is still the sort of number one, two and three thing to do. If you have to take an antibiotic, then there's a whole chapter in the book about choosing a probiotic and the timing is important. Ben, as you say. So you want to take the probiotic as far away from the antibiotic as possible. So if you consider most antibiotics are going to be twice a day, let's say you're taking it 8am and 8pm, then you want to take the probiotic at about 2 o', clock, kind of right in the middle of those doses, and you want to take it during the antibiotic use and then after, probably for at least a month and maybe at a double dosage, depending on what the antibiotic you've been on is.

Okay, so you take the probiotic at a separate time as the antibiotic. Like a two piece. If you're taking the antibiotic at 8am and at 8pm and then honestly, like folks, if you're listening in and you're on antibiotics or ever plan on being go into this book the Bloat Cure and I'll link to that in the show notes over@BenGreenfieldFitness.com Bloat because Robin goes into everything from how you should be eating prebiotic foods to using shiitake and maitake mushroom extracts to using Benchmark tonight Clay drinking ginger tea. She's got a whole bunch of things that you can do to basically limit the damage of antibiotics. I love that part of the book. So be sure and read that section if you would like. It's one of those things that I circle and underline. Those of you who follow me on Snapchat know I'm constantly posting like underlined sections of books that I read to Snapchat and this is definitely one of those sections I had underlined and taken some photos of. So I'll probably get sued by your publisher. But it disappeared within 24 hours. So okay, last, last question that I have for you. Just a little fun one here. So I'm not paleo. I eat beans. I eat legumes. I don't eat a lot of them, but I do include them. Like I'm not completely anti bean like I do natto and I'll do like lentils now and again. But you have a really interesting tip in your book to make beans more digestible and cause them to be less likely to get people who are sitting next to you on an airplane pissed or anything else. So what's your tip? What's the secret?

So you should know that beans, part of why they cause smell like acid in almost everyone is because they contain a carbohydrate called raffinose that is not digestible by most humans. We don't have the enzyme alpha angelactosidase to break it down. So if you use a sea vegetable like kombu, soak them overnight and cook them with a sea vegetable that really helps to break down the raspberry. And of course soak them using fresh beans as opposed or dried beans rather as opposed to canned beans which tend to be much more gas producing. Yeah, I'm a huge fan of legumes also. I think if you can tolerate them, you should have them.

And you talk about cooking them with.

Something called kombu, it's a sea vegetable. You can get it at Most health food stores.

Okay. So you just basically when you cook your beans, you cook them with this sea vegetable and that breaks down this raffinose enzyme.

Yes.

And so I obviously soaking and sprouting and fermenting beans is important, I know, to kind of like pre digest and get rid of some of the enzyme inhibitors. But I'd never thought about cooking beans with sea vegetables. That's really interesting. So the next time you make some chili, throw some sea vegetables in there.

It absolutely helps and it adds to the flavor.

I don't think the cowboys of the old west did that, but.

They also had crappy coffee and probably lots of gut issues. Well, there's obviously a ton that we did not get get into. That's in both these books. The Microbiome Solution and the Bloat Cure. I read them both. Obviously when I read a book and I like it, I try to get the author on a show. So I will vouch for both these books. They're not just full of crap that you read other places. They're actually interesting and full of advice that seems to be somewhat practical and in the trenches. Probably because Robin helps people poop all the time.

Well, they're full of good crap is what I like to think of it. Thank you.

Bet you're not just sitting in your mom's basement googling ways to poop. You're actually out there practicing this stuff and smelling patients butts.

Manually dis impacting people and smelling their butts.

That's right.

It's really good stuff.

Well, Dr. Chukan, thank you for coming on the show today. And for those of you listening in again, all the show notes, her books, everything that you need to poop like a champ and much more you can find over@BenGreenfield Fitness.com Bloat that's BenGreenfulFitness.com B L O A T and Dr. Chutkan, thanks for coming on the show and.

Thank you so much for having me. And for the record, I think you're probably one of the least bloated people I've ever met. So keep on doing what you're doing.

You know what I used to be when I was a bodybuilder? Horrible farts, horrible gas. I have fixed so much over time. My wife just loves me now when we wake up in the the morning and the room doesn't smell, it's just like night and day versus the first six years we were married. So yeah, it's big time happiness in your life, love and relationships when you fix this stuff. So yeah, that's it, folks. Thanks for listening in. And until next time, I'm Ben Greenfield along with Dr. Robin Chutkan signing out from BenGreenfieldFitness.com have a healthy week.

You've been listening to the Ben Greenfield Fitness podcast.

Go to BenGreenfieldFitness.com for even more cutting edge fitness and performance advice.

Sa.