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

Here's a number that made me realize that we have a gut health crisis hiding in plain sight. 40% of Americans say that their bowels disrupt their daily lives.

40%.

15% of Americans have irritable bowel syndrome. 3 out of 4 Americans can't poop in a public restroom. 1 out of 3 struggle to go to the bathroom on vacation.

I have wanted to do an episode on this topic for years. Gut issues, bloating, constipation, gas, IBS. And yes, you and I, we're going to talk about poop. Oh yes, we're going there. 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. Tricia Pasricha. Dr. Pasricha is a board-certified neurogastroenterologist, a physician scientist, and an assistant professor of medicine at Harvard Medical School. What is the gut specifically?

Your gut is a brain. You will think about the gut just as a digestive organ, and it is so much more than that. 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.

Okay, now here's a question.

Yeah.

Oh God, I can't believe I'm going to ask you this.

I'm so excited.

Hey, it's Mel, and before we get into this episode, my team was showing me 57% of you who watch the Mel Robbins Podcast here on YouTube are not subscribed yet. Could you do me a quick favor? Just hit subscribe so that you don't miss any of the episodes that we post here on YouTube. It lets me know you're enjoying the guests and the content that we're bringing you because I want to make sure you don't miss a thing. And I'm so glad you're here for this episode because this is a really good one. All right, let's dive in. Dr. Tricia Pasricha, I'm so excited that you are here.

Thank you so much for having me, Mel.

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 it with my friends, what's gonna change about my life?

Your life is gonna change in two big ways. First, you're gonna stop thinking about your gut as a digestive organ. You're gonna 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 superhighway called the vagus nerve. And also, so many of the diseases that we're 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 and agency to get the help that you need.

Wow. So, Dr. Pasricha, 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 can— I recognize the lungs. I see like a bunch of squiggly stuff, which I guess are intestines. But Dr. Pasricha is gonna 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 see.

Okay.

I promise you I'm not that heartless.

No pun intended. 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 from 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.

Mm-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 at 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 to this episode right now, but I've always thought the esophagus, the esophagus actually goes down the front. Like in front of— Do you see what I'm saying?

Not 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 good look at it.

It's behind the heart?

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 heartburn, 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 or the front? You perceive it as just being from your chest, but actually your esophagus is hiding all the way in the back.

Wow.

Mm-hmm. I'm gonna take this liver out here too, just so you can see better where the esophagus is going. So goodbye, liver. 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 the stomach, that piece of food is gonna enter the small bowel first. That is this long, windy tube that goes goes all the way around and is kind of bunched up in your abdominal cavity. 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.

Yeah.

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? It's 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.

Yeah, it'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 absorb the nutrients you need in the small bowel. Now it's the waste that reaches the colon. All the water's getting sucked out. So as it goes along this way, it's getting drier and firmer and harder. Eventually now—

Oh, I love that.

It makes its way to the back, all the way to the back to your pelvis. So this is a female model. I'm gonna 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 into the free world.

A lot of times we're ready. I know 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.

And thank goodness for those sphincters. The sphincters are the sphincters that hold it tight. You have control over your external sphincter. So if you say we are not ready, You can—

you're clenching 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 it's all the way at 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 I— 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 4 hours.

4 hours?

Yep. And if it's softer, easier to move through, doesn't have to do a lot of hard breaking down, like fibrous 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 bowel over the next day or two, hangs out in the colon. But, you know, we have control over that final step. And there's some people for any number of reasons who are gonna hold onto it a little bit longer than others. So it can take a day, 2 days, sometimes even longer.

Wow. But it's out of the stomach—

Within hours.

Within hours.

Yeah. And sometimes even again, within 30 minutes, if depending on what you've eaten.

Huh. 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, 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's going around.

Yeah.

Right? You're breathing in air or there's, uh, maybe some pollution. You're breathing in air. You're in, uh, standing next to somebody who's smoking. You're breathing in the air, 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— that that is protecting you from whatever was in the outside world? Yeah. That you then either breathed in through your mouth or you ate in 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, right? Like we're putting all kinds of different things into our body. We cook it. You know, relatively clean, but it's obviously 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. And at least 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 the small bowel, It's huge. If you think about, 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 enteric nervous system.

Enteric nervous system.

Enteric nervous system. You've 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 windy 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. Pasricha, there's, you know, 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.

Yep.

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 in doctors' journals they were talking about how it seemed like things like emotional stress seemed to cause this response, of all places, inside the gut. And there was a famous set 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 colonoscope. 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 Certainly 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 cramped in my stomach. It's like 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. And it wasn't until the 1980s, 1990s that my field, which is neurogastroenterology, 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 and 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 brain 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 really do.

It's more than a belief. I mean, thank God at this point we have decades now of data that's showing that this is true.

Well, I think it's like something that's super amazing to consider because that means 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, then you're left only with this set of tools and medications and treatments that are gonna address the brain in your head. That's all you have. So you're gonna be taking things like antidepressants, anti-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 this 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, right? Like, 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— that's 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 that's an important emotional processing hub. It causes the amygdala to signal to another part of the brain to release a hormone called corticotrophin-releasing hormone, or CRH. CRH does 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 Bathroom. Why does that happen right now?

Yes. Why does that happen? Why do I always have to pee or go number 2 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 to the bathroom right now?

Yeah. Well, early in my career, I discovered one of the mechanisms by which this happens. So what I did was I used a machine called an electrogastrogram. That's no— it's very similar to an EKG, which people use 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 3 beats per minute. But what I found is that when you're telling a lie, that regular rhythm of 3 beats per minute, it goes into total chaos. It doesn't contract anymore at 3 beats per minute. It enters this chaotic rhythm called arrhythmia 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, 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 the 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 we can make, we can use, and something that we should learn is that instead of just impulsively 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 are 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 in your 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 is 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, good or bad. 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, suppose we're on a 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 already wearing— date is already going so well.

Cool suit. She looks amazing.

Okay. Thank you. So date is obviously going well.

Very good.

They're complimenting you.

Yes.

And The conversation's going fine. And then maybe suppose that moment in the date comes where like your hand reaches out, their hand reaches out, fingers touch fingers.

Tingly.

Yep. Except nothing happens. Suppose you touch each other and that's it. You don't get butterflies.

You don't get butterflies.

Yeah. 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 what, the spark, it just wasn't there. I, 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 the right guy. And he may still not be.

There's 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 this 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 as 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 6 people that ghosted you. Please don't lean into this.

Yeah. And you don't know, this person could be different. 'Cause just remember your gut, 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 gotta pay attention.

Yep.

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 bowel syndrome. 3 out of 4 Americans can't poop in a public restroom. 1 out of 3 struggle to go to the bathroom on vacation. 1 out of 10 live with chronic unexplained pain every time they eat. 1 out of 10. And the kids are also not all right. In my own lab, we've found that college students, about a quarter of college students, spend more than 10 minutes at a time trying to have a bowel movement every time they go. And the crazy thing here is that most of these people would not identify as being sick. They wouldn't think necessarily that they have a problem. They kind of would've normalized all these symptoms, and that is the entire problem. The problem is that we are not having a loud 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 100% 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 adults would ask me was just this: are my bowel movements What's normal? And if that's the question that we're all asking as adults, it taught me that we've just been winging 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.

Please.

Because how do you want us, Dr. Pasricha, 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, what is it like? Because I think— because I'll just be— this might be too, too much information, but, you know, every one of us has a 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. Does that make— because now all the big tests that everybody's doing to figure out your full longevity 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.

Yeah.

Are dealing with this. 15% of people have IBS. 3 out of 4 people cannot go number 2 in a public bathroom.

Yeah.

In fact, I was having a conversation this morning with a couple of colleagues, both of whom admitted they don't go number 2 at work.

Yeah. And we're at work, what, 8, 12 hours a day? I mean, think about how many.

Now is— and I think most of us think it's psychological. But I don't— maybe it's not. And I think it's insane that 1 out of 3 people can't go to the bathroom when they're 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, it's been 7 days since I've gone number 2.

100%. Yeah.

Well, okay, so let's talk about that. Like, what is— 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's 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, I don't look.

I think they're lying even to you as the doctor.

Like, what are we here for then? 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 gonna get into, that gives you a lot of information. How 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 all of a sudden felt bad as a mom because I'm thinking about those diapers that you change where your sweet little baby's there and you're like, oh, what is this? This is like, oh my gosh, mustard poop. It smells terrible. And so our reaction to it also creates this, like, embarrassment and shame around something that's so normal.

I'm so glad you said that. I— from day one, we treat our bodies, our bowel movements, as this nefarious entity. Like, it's so embarrassing, it's so yucky, it's so icky. You shouldn't make poop jokes, it's so horrible. And, 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, right? Like, we go to the dentist a couple of times a year and they're like, hey, did you do 2 minutes each side? Make sure you 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, um, 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, they'll be like, oh, just 5 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 Miralax, you exercise, you think, you know, you've done what you can. Maybe you've even tried a prescription medicine and it's not working. Consider that you could be in that 1 in 3, which is so common.

That's 33%.

Mm-hmm.

There are 4 of us in this studio right now.

Well, it should be 4 of us with constipation. 4 of us with constipation, then.

Yes. Well, I'm sure I'll, I'll just speak for all of us. 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 gonna be, I'm afraid you need this medication, you're gonna 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 8 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 1 out of 6 people who seem to have pelvic floor dysfunction like this, 1 out of 6, 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 stilettos. Raise their knees above their waist.

I'm going to put my heels on and go. Go number 2, Kris. It'll help. Yes. Well, you know, it's funny. Funny you say that because our, every time our adult kids are home, I walk into my own bathroom and the garbage can is right in front of my toilet.

Yeah.

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 on to it. That actual, yeah, 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 colon.

And it's kind of curved as it comes 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 closed. That's a good thing. This muscle saves our butt.

That's— that's how we don't poop our pants, right?

Thank you.

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.

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Yeah. One of the most common things that people come to my clinic 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 take?

Less than 5, ideally less than 1 minute. Okay. It should be an in-and-out job.

Wow.

Yeah. But if you're having a, 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 those 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. Sometimes people complain about a lot of urgency, like they're just interrupted by— they're at work, they're out with friends, and suddenly out of nowhere they have to go to the bathroom and have to do it now. There are a lot of people, 1 out of 7 people, okay? I want to just internalize this number: 1 out of 7 people poop their pants regularly. In America. That's what the studies have shown. So people feel so isolated sometimes and 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, like, brings it up at your book club, a lot of people in that room will have experienced what you're experiencing. So sometimes people talk about that. Bloating, 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 it's 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 them trouble? These are the kinds of people who come into my clinic. And of course, as I said, a lot of them have anxiety anxiety and depression, certainly a lot of them, stress fuels these problems and makes them worse. But oftentimes it's not the stress that's the primary problem.

Or the anxiety or the depression.

Exactly.

It's that your gut 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 gut symptoms should you never ignore? Because they signal that something bigger could be happening?

Yeah. Let me tell you about two. Okay. And this is, this is one that I want people to pay attention to 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 a, a big, 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 4 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 4 symptoms are: 1, abdominal pain; 2, rectal bleeding; 3, iron deficiency anemia. 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 anemia, and it can feel like fatigue, you're 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, wait 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, 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 really, really thin. Anything that's new for you that seems to stick around, get attention, because this study found that people who have 3 or 4 of the 4 symptoms I just mentioned they had a 6-fold higher likelihood of having colorectal cancer than people who had fewer.

6-fold?

6-fold.

So you've got stomach cramps, stomach, 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 go get help for any of these symptoms. No more than 1 or 2 weeks if it's persistent. And there have been some really high-profile cases of celebrities who have said, the only sign I had was that fourth one, just that something changed in the pattern. And I thought it was like my coffee or something else, but it— then I changed the coffee and it didn't go away. If you are worried, if something's off, don't wait, don't brush it aside as normal. Do not be embarrassed by it. Just run it by your doctor.

Dr. Fustericher, 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 an important question. It's a big question. We used to think about cancer in general as being a function of our genetics 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.

Yeah, don't you think it's ultra-processed foods?

Ultra—

And all the chemicals and crap that's in food that's packaged and that people are, especially here in the United States?

I really do. And there have been some major studies that have linked colorectal cancer specifically at a younger age to ultra-processed food consumption.

Is, 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-processed foods?

It's a global trend, and that's what's really worrisome. And of course, the rise of ultra-processed 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 in 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-onset 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 time since the 1980s, 1990s, alongside with ultra-processed foods. And so it's probably a combination of a lot of different things. I, 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 is 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, it can't be ultra-processed food. I hear this a lot. Like, it can't be alcohol, it can't be ultra-processed food because—

How can it not?

Honestly, like, And people will say like, well, my aunt, you know, drank, you know, 7 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 is how I explain it. Some people start out life with 5 blocks stacked against them and it only takes 10 to get cancer. You, your aunt may have started out with just 1 or 2 blocks. And then suppose you eat a lot of processed meats every day. There's 1 more block. You grow up in a town where airplanes pollution is really severe, there's another 2 blocks, and then suddenly you've hit 10 blocks and somebody who's had other patterns of behavior— they're more sedentary than you, whatever 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 colorectal cancer in these cases that we've been seeing rising, they start in our childhoods. They start at a time when we may or may not have had that kind of control over our lives.

Yeah. Wow. So your bestselling book, You've Been Pooping All Wrong: How to Make Your Bowel Movements a Joy. Congratulations. It focuses on how much you can learn by just focusing on your bowel movements. So can you explain to the person listening all the things that you can learn about your health just by turning around and taking a look at the information that is in the toilet bowl?

Yeah, 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, will 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 and our food. It's going to tell you about how the brain in your gut is working. You're gonna 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.

Me too.

Let's start with, with what is normal, Dr. Pasricha, and what is not normal when it comes to poop?

For me, a normal bowel movement has to do just two things. One, it should be effortless. You shouldn't have to be straining. You shouldn't spend 20 minutes in there sweating, straining your eyeballs out. Two, 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 are you going? And it turns out anywhere from 3 times in 1 day to once every 3 days is in 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 holding— Dr. Posricha is holding up poop. But I have to give a shout out to our team.

Oh my God.

Because our team, creative geniuses. Ordered Play-Doh, and I cannot believe how realistic this is. It's almost like I can smell it. On the right, you're seeing a log that is— this is embarrassing. You're seeing a log that's maybe— it's like a bratwurst. It's like about the size of a fat hot dog. And it's— you can see there are lines in it. So it's almost like parts of pieces of poop have come together to create the bratwurst. And then the one on the other— the other one, because there's two here, is about 4 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 sink to the bottom that kids dive for, a torpedo. Yeah.

Yeah. I think what you're describing— first of all, beautiful 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. Pasricha. 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 wipeless 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 the smooth torpedo shape?

Yeah.

Is that like, that's, is that evidence of somebody who's got a lot of fiber? That's a fluffy bowel movement?

This is, this is a lovely poop.

So these are, these are good. You're giving this an A. These are good. Either one of these are acceptable.

You totally. Totally. You get an A for this. You also, in my books, could make an A or an A- if it's even softer. I can see why the team might not have been able to really show softer stool in their clay model.

What do you mean? Like it's got kind of some water with it?

Yeah, it's a little fl— like a little bit less formed, a little bit more floaty, a little softer. You could still get an A for those two. 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.

But if there's some shape to it and it's even fluffier than this beautiful sausage, you're still winning.

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 and 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.

You've 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 in a way.

It's a little freaky. You should have been a gastroenterologist. 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 at 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—

that's falling 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 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 be— hopefully I'll be back here in an hour or two. But this is just— that's not even an appetizer.

That's a C-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 and 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, Dr. Prasrecha, that 3 out of every 4 people do not go number 2 at work.

Yeah.

If you're somebody that is clenching, Yep. All day at work, which could be 10 to 12 hours, you gotta 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 Right. 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 bothers you, but go at 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 gotta do all the work yourself by doing a harder and harder Valsalva, by 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 gonna be hard. It's going to be way harder now.

Huh. And what is the one on top that is kind of in a log 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 in 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, 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, um, like, you know, you go number 2 and the bowel movement has one section that's darker brown and then it kind of, you know, has the ombre effect of changing color? Does that make sense? I've I know you're a GI doc. You know, you know all 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.

Ew. What?

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 good stuff.

Wait a minute. So when I have, but unless there's corn, 'cause you see the corn in your stool.

Yeah. All of the same stuff.

How does corn make it through?

Yeah, everything you can't absorb. We cannot absorb and digest and break down corn.

It's fiber.

Why? Because it's fiber.

Am I not chewing it enough?

You can chew your heart's content, but we don't contain the enzymes and the machinery to break down 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 a surprise to me that it— sometimes those little chunks and pieces come out and we say, oh, there must be a problem with my 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, half the time I can tell them what they had for dinner two nights ago. You can see bits of it, especially if they've eaten a lot of salad or something like that. That's normal. What we poop— first of all, the brown color, that comes from bilirubin. 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, as 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 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 smell poop.

I know. I don't, I don't even feel good, like wiping this down. Okay. So 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, Mel?

Okay.

I'm going to hand these over to you.

Okay. Okay. Yep. I got—

Have a look at them.

Yes.

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 if they're normal or abnormal.

All right. I'm going to describe them.

Yeah.

So apple green. I'm looking at an apple green Pantone. So imagine a Granny Smith apple.

Oh, and it kind of matches my sweater.

Yes. That to me looks like the kind of diarrhea a baby has after they've had breast milk. Yeah.

I mean, this is a lovely, bucolic shade. I would say, first of all, everyone's 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 greens powders, people actually can get the occasional green-colored poop. If it's rare, you don't necessarily 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, talk to your doctor.

Oh, that is like a, a color that you have if you have the flu.

Yeah, exactly. That's right.

Yes. Because things are moving quickly.

Yeah.

Through your system typically when it's that color.

That's right. You tend to get diarrhea, especially with 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 beet salad.

I was gonna ask you if you had beets last night.

Yes.

Yeah. If you have this color and you've had beets, you're good. You don't need to necessarily panic unless you're feeling dizzy or lightheaded. If you haven't had beets and you see this color, it's 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 have already decided this is hemorrhoids, you've gone through and 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 Pantone is called Lightest Sky. And this looks like a, the one of those White Walkers from Game of Thrones. This is what I would call zombie horrifying, like goose poop. It's like really grayish white.

It does look like the kind of stuff that my dog used to eat. You know, 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 how I told you that our poop is actually only brown because we have bilirubin?

Yes.

If we took that bilirubin away, this is the color our poop would be. It would be like this pale clay. What? Isn't that surprising? Isn't that bizarre?

It's bizarre!

It's clay-colored excrement. If we took the bilirubin out, so when we see this color, it tells us there's something blocking our bilirubin. It could be a gallstone. It could be something more worrisome, even like a cancer. If this has been going on for 1 day, 2 days, call your doctor immediately, 'cause this could be a big emergency.

That's what color it would be?

Yeah.

Well, 'cause I mean—

Isn't it kind of lovely?

Well, it is. It's a lot prettier than, but you would, you'd have to have a different color toilet paper 'cause you wouldn't know if your poop was white, whether or not you got it all. But here, here's what, here's what I'm gonna 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, ugh, 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 all the good stuff.

What does bilirubin do? Why is it in there?

It helps with digestion. It helps break down with the food, or 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, 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-colored poop.

Okay, this next one is Pantone 5125. They don't have a, they didn't name this one, but it looks like eggplant. It looks like a beautiful, shiny purple eggplant. And I've, I don't think, well, I feel like I may have seen like a little, but it's probably the beet. It probably was not that purple specifically.

I've definitely seen one or two of these in my lifetime.

Okay.

It's, this is one of the ones.

Like you're talking like a whole, like long log of that?

Or pieces of it. Okay. 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 and certain nutrients, like in berries, for example. Okay. Those can give you a purple poop. They can give you like a bluish-tinged poop even sometimes. And they're actually, they're there in like red wine too. If this is like a pattern though, we do wanna 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.

'Cause that's blood.

Yeah. But if you're like, I just ate I ate 2 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. Oh, the beets.

This makes sense.

Oh, the blueberries. Okay. But if that comes out of nowhere.

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, let me just—

Well, so what does that tell you though?

Usually it means—

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 an orangish 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 emergency room.

What does that mean?

This is bright red blood usually.

Oh, okay.

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 outpouchings in the colon that can bleed.

So how much of that color? In a log or pellet or whatever? Like how much? Well, 'cause, you know, occasionally you have, might have a little streak there.

100%.

And it happens once, 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, which is bright red, even if it's a little bit, you have to run it by your doctor.

Okay, now here's a question.

Yeah.

Oh God, I can't believe I'm gonna ask you this. I'm so excited. Should you go get like a sandwich baggie or a dog bag and grab it?

Yeah.

And bring it with you if you're going to go to the doctor or the hospital? Well, it's like I always say, because we do that for the vet, 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. Picture's good enough.

Don't have to bring in the poop. Yeah, picture it didn't happen. Okay. So 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, help me make a decision about it. But if you see this, like I said, And I wanna 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 4 signs of early onset colorectal 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.

You got that?

Okay.

All right. Pantone Pirate Black 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?

Oh, okay.

Okay. Well, I don't know. I'm like, if that came out of me, I would be like, I am rotting from the inside out.

It can be a big emergency. So this is not one that we say, oh, let's just see what happens over the next couple of days. This is one that you go talk to your doctor because 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 got to 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 black.

Oh, no kidding.

Yeah. And ironically—

When should you take iron? I'm so confused about iron. Like, are you supposed to take it with food in the morning, in the evening? Does your, does your poop get harder? I mean, like, I started taking iron. 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 common side effects of iron pills. So usually I tell people— actually, there's two things I tell people about iron. One, you don't actually have to take it every single day to replete your iron stores. You can take it every other day.

Okay.

And you actually, like, end up getting the iron you need because you can only absorb so much at once. And sometimes every day is actually overkill. That can help with the constipation. Mm-hmm. 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. Got it. Okay. Wow. So helpful.

The more you know.

Yes. I've heard you talk about the 5-minute toilet rule. What is that?

Yes. People should not spend more than 5 minutes at a time in the bathroom.

If you're in there for 5 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 smartphones, right? And the reason this is important And 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 smartphone 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 smartphones into the toilet with them, they are more than 5 times as likely to spend more than 5 minutes at a time in the bathroom. And they're at a 46% increased risk of having hemorrhoids. We saw them with our eyes.

You're kidding me.

Yeah. And you know what we think is happening is that, I mean, we get distracted with our smartphones when we're trying to go to sleep, when we're waiting in the line, something like, why would we not be getting distracted beyond belief in the bathroom when we bring our smartphones 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 is no pelvic floor support, and our hemorrhoids are actually just engorged veins. That's all they are. And so as we're sitting there in that vulnerable, unprotected way, those veins are just passively filling. And if we do that and we put that pressure on our pelvic floor for longer and longer periods of time, over days, over years, this becomes our pattern. We think that's how we get hemorrhoids.

Holy cow. So that actually makes sense. So let me just make sure I'm following this.

Yep.

So hemorrhoids. And like, explain to the person listening who's never had a hemorrhoid, because there's a person in our family that got one for the first time. Oh, and it was a whole— I— somebody should do a sitcom episode about it and Preparation H and the panic about what one should do with it and the horror to understand that mom and dad actually had Preparation H already in the house. This is normal people get these things. And so you have to put that up there. What? And so I— a hemorrhoid. I always thought a hemorrhoid was like irritation of the skin.

Yeah.

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. Internal hemorrhoids. Those are just inside the sphincters. 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 bothersome ones that can be itchy. They can be irritated, inflamed. 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 it pops down.

Oh, it, like, hangs out?

It can hang out. Oh, God.

It's like an udder.

Yeah. People know they have those because they can kind of push them in and out. Oh, I 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 H or these like mild steroid creams can like really help get you through it. And then sitz baths. Sitz baths are just like a fancy way of saying sit inside a bath of 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, Dr. Pasricha, 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 husband and I 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 leaves 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 2-ply, which is this guy, 2-ply, and then 1-ply.

Yeah. Puffy and thin. Expensive, cheaper.

Yeah. Yeah. Yeah. And I don't know who needs to hear this right now.

I do.

Okay. I want you to repeat after me, Mel.

Okay.

Okay. I am worthy.

I am worthy.

I am enough.

I am enough.

I deserve 2-ply toilet paper.

I deserve 2-ply toilet paper.

I mean, look at this. This is 1-ply. All right? This is pathetic. You don't need this on the most delicate part of your body. and that's your rear end. The tissue down there is so thin, so delicate. Do not give it this pathetic one-ply. And furthermore, 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 gotta run for the hills.

That's a red flag.

We've talked about red flags. Forget about a gut feeling. If you see this 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 thick wad that you are breezing through that pathetic thin roll more so.

It's true. You use less. Yes, yes. I also feel richer when I buy two 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 bidets.

Okay.

Yeah. And I know a lot of people in this country are not ready for that conversation.

Explain what a bidet is for somebody who doesn't know, because that was, that was another eye-opening experience. Recently when we went to a very nice hotel and one of our kids were like, whoa, this thing just sprayed me. What was that?

Yeah, a bidet is going to 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 bidet, the simplest form of a bidet is simply a nozzle that sprays your exterior clean. That's all it can be. Now, that's one end of it. Of it. These simple nozzle attachments are like pretty cheap. You can install them yourself. On the other end, there are beautiful luxury bidets where you have a heated seat.

So, well, then I'm going to spend more than 5 minutes in there if I've got a heated seat. That's a problem.

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 bidets 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 bidet. Really?

Even if your hands don't touch your butt, they just touch the tissue paper?

You think that's what's happening?

Even with 2-ply?

Even— actually, I don't remember what ply it 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 day?

No.

No. You would 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 a 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 our rear end up front to decrease the risk of UTIs, urinary 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 too. A gentle dab keeps you from from creating these microscopic tears, smearing it in. I really think that like sometimes when we're like just scraping our bums, a lot of people have sensitivity in that area. So people who have fissures, who have hemorrhoids, women who are postpartum, I tell all my postpartum patients this, just a gentle dab is all you need.

So Dr. Pasricha, 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 neurogastroenterology. This is what we study. What we study is increased intestinal permeability, and that's where this idea of leaky gut first started. So increased intestinal permeability is simply this: our guts are lined with these cells on the surface, and those cells are usually pretty tightly close together. Together, but different things happen throughout the day that cause the junctions between those 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 increased 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 and toxins hit your liver and cause damage. That's probably one of the cleanest stories in, in GI that we have for what increased intestinal permeability 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 gut." And everyone will say, "Wait a minute. Yeah, of course I have brain fog. I am bloated all the time. I've never heard of this thing called leaky gut. Is that what this is?" Because these are symptoms, bloating, brain fog, that are notoriously difficult to understand, difficult to treat, difficult to get help for. And now somebody's offering you an answer, which is leaky gut. 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 reel will be like, and this is my 3-step supplement that will fix your leaky gut. And actually, what you want to ask yourself is, 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, Mel, 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. Oh, you know, 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 But 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, 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 going to 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 going to work consistently that we can make a good recommendation for it and feel ethical about doing that. Here's the thing that I think people don't understand about the microbiome. So if you think about your microbiome as 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, in theory, the good bacteria.

Yep.

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 as bad because they seem to be 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 a good bacteria is the cause of that condition or is the cause of your health. Because what if the bacteria we're seeing that we're calling bad are actually just the bacteria that are naturally growing in response to the fertilizer you're giving it, and they'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, them, but you need to focus on prebiotics. Prebiotics are like the fertilizer and the conditions that allow 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? I've had vegetables. Have I eaten something fermented? And sometimes that's the way that you can nudge the bacteria populations in your gut one way or another.

Amazing. Now, Dr. Pasricha, as a neurogastro 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 gonna 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 5 different vegetables and fruits. And it would happen for me like several days a week and then it just like wouldn't. I have 2 kids, I have like 3 jobs. I'm just a normal person who's trying to get through the grocery store cereal aisle like everybody else. And then 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 of being so virtuous about how I was gonna meet my fiber meets my fiber needs, I said, okay, let us just like plan on me not meeting my fiber needs through my diet. What am I gonna do then? And then it clicked. And then I found the laziest possible solution to just give my gut the, the exact thing that it needed. And so I started taking a fiber supplement. So I take psyllium every day. Psyllium 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 psyllium so wonderful. The cardiologists have loved psyllium for even longer than we have in gastroenterology because it can help lower cholesterol, and we have that in my family. Um, but it's also a shape-shifter. So if you have diarrhea, psyllium will add a little 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 the shortcut that like freed me up and is a no-brainer because I'm not adding any extra time. 1 teaspoon of psyllium gives you about 4 grams of fiber. So if you have 2 teaspoons, 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 exceed them that day. And on the days that I I still get an A+ because I've met them because I'm just doing the laziest possible thing and it, and it works.

Sounds like the smartest possible thing. Dr. Pasricha, 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 to work, 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 Treating it as the most precious organ of your body is not optional. It's foundational to your entire health.

Dr. Posricha, 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 Play-Doh 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 Robbins 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 Dr. Pasricha 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 righty. I will welcome you into the very next episode the moment you hit play. I'll see you there. And thank you. I am so excited that you were here for this. Thank you for sharing this with your family. Thank you for sharing this with all your friends. I learned so much. This was so cool. And I know you're thinking, all right, Mel, shush, what's the next video? I love this. We're on a roll. Let's keep going. If you loved this, you definitely are going to watch this video next, and I'll be there to welcome you in the moment you hit play.