The Mel Robbins PodcastMaster Class on How To Fix Your Digestive Issues & Gut Health (With a Renowned GI Doctor)
EVERY SPOKEN WORD
150 min read · 30,151 words- 0:00 – 4:08
Intro
- RCDr. Robin Chutkan
I am so curious about your poop.
- MRMel Robbins
Oh.
- RCDr. Robin Chutkan
I- I- I made a bet-
- MRMel Robbins
What do you wanna know about my poop?
- RCDr. Robin Chutkan
I think- I have a feeling that you have wonderful poos.
- MRMel Robbins
Do you really wanna know?
- RCDr. Robin Chutkan
Yes, I really wanna know.
- MRMel Robbins
Okay. How often should you be going?
- RCDr. Robin Chutkan
We have this textbook definition that it's, you know, three or more bowel movements a week is normal, but very arbitrary number. It should absolutely be a daily thing. It's eliminating dead blood cells, it's eliminating bacteria, toxins, et cetera, undigested food particles. That stuff is not supposed to be gumming up your colon just sitting there.
- MRMel Robbins
Let's talk probiotics-
- RCDr. Robin Chutkan
Yeah.
- MRMel Robbins
... because they are everywhere, everybody seems to be on one. So as the gut expert, Dr. Robyn, do you need to take a probiotic?
- RCDr. Robin Chutkan
You need to eat an apple over taking a probiotic.
- MRMel Robbins
What are the three small habits that you would like us to start implementing into our day-to-day life that will get our gut system working correctly?
- RCDr. Robin Chutkan
I would say it's hydration, it's movement, and it's (clock ticking) .
- MRMel Robbins
Hey, it's Mel. I am so glad you're here with me today. It is such an honor to be able to spend some time with you today, and I wanna acknowledge you for choosing to listen to something that can help you create a better life. I think it is so awesome that you're taking time for yourself, and I love spending that time with you. If you are a brand new listener, welcome to the Mel Robbins Podcast family. I'm Mel Robbins. I'm on a mission to inspire and empower you with tools and the expert resources that you deserve so that you can create a better life. And, you know, the other day I read this crazy piece of research. Did you know that two-thirds of people have a gut issue? And you wanna know the age group that is the most affected? This one really surprised me. 18 to 44 year olds. Yup, it's not- it's not your grandparents. It's 18 to 44 year olds. 73% of people in that age range have a gut issue. So if you're feeling bloated or you're constipated or you have IBS or you're constantly popping the Tums and you wish that you could do something about it or maybe somebody that you love has one of these issues, well, I have booked you and me an appointment with the number one gut health medical doctor. I think she's absolutely amazing. I'm talking 30 years of medical experience. And she's here to just set the record straight with the medical facts. She's gonna say throw out your supplements and the probiotics, because there are simple things that you can do, in fact, you should do starting today, to have a healthier gut, to beat the bloat, settle your IBS, and address constipation once and for all, which you will also learn may be caused by a very surprising issue in your childhood. And you're also going to learn the extraordinary role that your gut health plays in your immunity, energy, mental health, estrogen production, and so much more. This is a masterclass on your gut health that absolutely everyone that you know needs to hear. So let's jump in and please help me welcome Dr. Robyn to the Mel Robbins Podcast. Dr. Robyn, I am so fired up to talk to you today.
- RCDr. Robin Chutkan
I'm so excited to be here. Thank you so much for having me. We're gonna go all things gut. Not just the obvious things, but we're gonna talk about gut brain, gut immune, how the gut is your engine for your entire body. It drives all the processes. And I think we're gonna really give people a new way of looking at the gut and how powerful it is.
- MRMel Robbins
Absolutely. And what I also love about your work is you take all the science and distill it down into simple things that I can do. You listening are gonna be able to walk out of here and know exactly what to do to take care of your health, to make your gut better, and you're gonna understand why this matters so much. So, Dr. Robyn, here's where I wanna go next. It does seem like everybody I know has a gut issue, like the bloating and the IBS. Are you finding
- 4:08 – 6:12
You will be SHOCKED when you find out how many people have gut issues.
- MRMel Robbins
that in your clinical practice, gut issues seem like they're on the rise?
- RCDr. Robin Chutkan
They're absolutely on the rise. And as a gastroenterologist, all I see are gut issues. So, you know, I've always seen a lot of gut issues, but if we look nationally, there was a study done last year by MDVIP and they found that two-thirds of Americans suffer from gut issues. The highest number is in the 18 to 44 age group.
- MRMel Robbins
Why?
- RCDr. Robin Chutkan
73%. I think it- a lot of it has to do with the food that they're eating, they're eating more ultra-processed foods, they're busy, they're on the go. I think there's a lot of stress, and that has a profound impact on the gut. And I think they're also more aware, which is good, right? I mean, it's- it's good to be aware that, hmm, this isn't functioning properly. But that's the highest percentage. And what they found, uh, the American Gastroenterological Association did a survey and they found that 40% of Americans, and this is across a board, said that they had GI issues to the point where it was interfering with socializing, with running errands, with exercising, with having sex, with libido.
- MRMel Robbins
Wow.
- RCDr. Robin Chutkan
And to me, the really frightening part of all of this is AGA launched a campaign aro- called Trust Your Gut around this. One in three Americans do not feel comfortable talking to their doctor about gut issues and will only raise it if the doctor asks. It's like, don't ask, don't tell, because of embarrassment. And honestly, Mel, this was a reason when I read this last year, I was like, "Oh no, I've gotta do something about this." Like, I want people to be a medical detective. Like, you turn around and take a look at that poo, you tell me what it looks like, if you need to poke around in it with a stick. Understand, why do you have gas? Why are you bloated? Why are you backed up? We have to educate people about this, how this works. And the education that I see out there is mostly the biohacking, take this supplement, do, you know, this crazy diet. That's not fixing things for people. I mean, the more of that we have, I think the sicker people are. So what we really need is we need people to understand-... how this stuff works.
- MRMel Robbins
The basics. Yeah.
- RCDr. Robin Chutkan
Yeah, the very basics.
- MRMel Robbins
For the person who's listening,
- 6:12 – 7:44
If you are dealing with gut issues, listen to this advice.
- MRMel Robbins
who is in the two thirds who are ha- experiencing a gut issue, they love somebody who is, what is available to them if they truly take to heart everything that you're about to share today, Dr. Robin?
- RCDr. Robin Chutkan
Not only is it possible for you to feel better in your gut, because your gut is your engine, it's possible for you to feel better in your whole body, for you to have a clearer mind and less brain fog, for you to feel less fatigued, for your immune system to work better so that you're not overreacting to things with food allergies or you're not under-reacting to things where you can't clear infection. So the gut is a thing that unites all these different organs, and that's a thing that makes me so optimistic. Because unlike when you think about genetic diseases, you know, you sort of get what you get. You don't get upset. You're dealt a bad genetic hand. But our gut is changing all the time. When we think about our gut microbiome, which I know we're gonna talk a lot about, we know from a study that was published in the journal Nature in 2014, they put people on a sort of heavy high animal protein, high fat Atkins type diet, and then they rested them for a week and they put 'em on a diet that was more plant focused. And they found that within 30 hours of the food hitting the gut, things changed dramatically. The bacterial composition changed, the genetic composition changed in terms of the genes that were turned on and off. And the great thing here is you don't have to be a vegan. You don't even have to be a vegetarian. You just have to eat more plants. You have to do some basics. And in fact, the
- 7:44 – 9:47
This study about gut health has surprising findings about your diet.
- RCDr. Robin Chutkan
American Gut Project study from 2019 that asked the question, "What do you have to do to have a super healthy microbiome?" They found that the label was completely unimportant. Carnivore, omnivore, vegan, pesco- pescatarian, lacto-ov- it was simply the number of different plant foods people ate, with 30 or more different plant foods a week being the magic number. So you can have your porterhouse or whatever it is that you're gonna have. I mean, all my vegan friends will be very upset, but from a health point of view, there are reasons to consider eating less animal protein in terms of the ethics and climate change, et cetera. But from a health point of view, you can definitely tolerate a little animal protein on the plate. You can tolerate a lot of things on the plate if you are crowding it out with enough of the healthy stuff, with some plants and some water and some movement and some of these basic things.
- MRMel Robbins
You just said 30 plants. So are you saying 30 different types of plants or are there 30, like, ones that are better than others?
- RCDr. Robin Chutkan
30-
- MRMel Robbins
Like, as the gut doctor-
- RCDr. Robin Chutkan
30-
- MRMel Robbins
... what should we do?
- RCDr. Robin Chutkan
... different plants per week. And when I say plants, you get credit for fruits, vegetables, nuts, seeds, herbs, spices, beans, whole grains, all of 'em.
- MRMel Robbins
Oh. Well, if we include spices and nuts and grains-
- RCDr. Robin Chutkan
Absolutely.
- MRMel Robbins
... like that, absolutely you could get 30 different things, 'cause I would imagine the vari- well, like, is the variety also important?
- RCDr. Robin Chutkan
The variety's important because they all contain different things. When we think of these phytochemicals, so you think- eating the rainbow is always a good way to do it. So you get different things from the oranges and you get the lycopene from the reds and you get something else from the green. And so eating a variety, eating seasonally is another great way to do that because you're not in the same sort of peas, carrots, broccoli heavy rotation-
- MRMel Robbins
Yep.
- RCDr. Robin Chutkan
... for, you know, 365 days. And it doesn't have to be a lot either. I mean, you're getting enough from, you know, a little handful of berries is plenty. You don't have to eat a whole quart of stuff.
- MRMel Robbins
So as the gut expert, Dr. Robin, what do you eat in a day? Will you walk us through, like, breakfast, lunch, and dinner?
- RCDr. Robin Chutkan
Absolutely.
- 9:47 – 11:29
Renowned GI doctor Dr. Robynne reveals what she eats in a day.
- RCDr. Robin Chutkan
I like to start off with a green smoothie in the morning. Collards, kale, spinach, celery, parsley, mint, a little bit of fruit, usually green apple, lots of lemon. I like to use unsweetened coconut water for the base. So when I drink that, it's like a liquid salad in the morning.
- MRMel Robbins
Mm.
- RCDr. Robin Chutkan
I mean, I feel so good when I have that. So I usually have that in the morning. If I'm still hungry, I'll usually have something highish protein, maybe a little bit of smoked salmon, some eggs, or maybe a sweet potato and kale hash. I love that too.
- MRMel Robbins
And then what do you do for lunch?
- RCDr. Robin Chutkan
Lunch is usually soup.
- MRMel Robbins
Soup?
- RCDr. Robin Chutkan
I'm a big soup person. Yeah.
- MRMel Robbins
Okay.
- RCDr. Robin Chutkan
Soup and, uh, there are a bunch that I make. My husband makes really good soup too. So it's usually split peas or lentils. Sometimes it's just a broth. I do a really basic soup that's leeks, onion, garlic, and scallion sauteed, and then I just blend it up with some broth. Delicious.
- MRMel Robbins
Yeah.
- RCDr. Robin Chutkan
Sometimes a little curry powder, depending on how I'm feeling. But that's all the good stringy high inulin fiber that's really good for your gut microbes. So some kind of soup. Sometimes it's a heartier soup. And then dinner is usually protein, starch, veg, plus salad. My husband's mostly vegan. Not all the time. Special occasions he might eat some meat. So he's usually not doing the animal p- he's almost never doing the animal protein. He's usually doing lentils, brown rice, sauteed collards, and salad. And I'll have all of that, but I may have a little piece of fish or some broiled shrimp or something. But it's lots of legumes. It's lots of beans and greens basically. And then some whole grains. Uh, love brown rice. Eat it probably most days. Love squash, sweet potato, yams, yucca, all of that stuff.
- MRMel Robbins
No wonder you're glowing.
- RCDr. Robin Chutkan
(laughs)
- MRMel Robbins
You're like, you- this sounds absolutely amazing. So do
- 11:29 – 18:52
Dr. Robynne’s HOT take on probiotics.
- MRMel Robbins
you need to take a probiotic?
- RCDr. Robin Chutkan
You need to eat an apple, overtaking a probiotic. Yeah.
- MRMel Robbins
Really?
- RCDr. Robin Chutkan
This idea probio- and, and I will say, I will say for the record, there is dark chocolate happening every day for me.
- MRMel Robbins
(laughs) Oh, thank God.
- RCDr. Robin Chutkan
Tons of fruit and lots of dark chocolate.
- MRMel Robbins
Okay.
- RCDr. Robin Chutkan
And I have been known to eat a bag of Doritos on a road trip.
- MRMel Robbins
Got it.
- RCDr. Robin Chutkan
It has happened.
- MRMel Robbins
Okay. Well, I knew I liked you.
- RCDr. Robin Chutkan
Yes (laughs) .
- MRMel Robbins
But let's talk probiotics-
- RCDr. Robin Chutkan
Yeah.
- MRMel Robbins
... because they are everywhere. Everybody seems to be on one. And as the gut doctor, what's your opinion about it?
- RCDr. Robin Chutkan
My opinion on probiotics is like multivitamins.Do we have clear and compelling evidence that a multivitamin does anything for the average person? We don't. What we know from some studies is that people who take vitamins also have healthy habits. So vitamin takers tend to be exercisers and clean eaters, es- and meditators, et cetera. But we don't have evidence outside of that that the vitamin itself in a healthy person. So it may help, it can't hurt. Even something like a probiotic, if you're taking multiple different species, those bacteria, assuming that there are actually live bacteria in the probiotic, 'cause there's very little regulation, a lot of times the bacteria are dead, but let's say there are. Let's say the product does contain what it says it contains, these live bacteria. They are potentially competing for resources with other bacterial species, even the native ones in your gut that are actually working and trying to do their thing, and now they're like, "Oh, wait, there's not enough of, you know, whatever resource this is we need to eat." And so you can be altering your microbial composition for the worse by taking a probiotic.
- MRMel Robbins
Oh, God. Now- now, well, I feel like I'm in the camp of everything you just said. It can't hurt, and so I'll just keep, like, taking all these things and my body will just pee out whatever I don't need, so that's one mistake I'm clearly making. Second mistake that I'm making is I- I'm taking the probiotic and then I'm taking a different probiotic and then I'm also eating the yogurt and the kimchi and I'm just making this gigantic sort of bacteria salad (laughs) .
- RCDr. Robin Chutkan
But eat the kimchi for sure.
- MRMel Robbins
Right.
- RCDr. Robin Chutkan
I mean, we have great data on fermented foods, and a lot of this is from, uh, the Sonneborn lab in- at Stanford. So kimchi and sauerkraut are this powerhouse combination of pre-, pro-, and post-biotics. And there's really compelling data that eating even a tablespoon of sauerkraut a day can provide multiple different species, important metabolites, so this is ultimately sort of medicinal food.
- MRMel Robbins
Wow.
- RCDr. Robin Chutkan
Things like the sauerkraut and kimchi. So by all means, keep doing that, for sure.
- MRMel Robbins
So, Dr. Robin, what's the difference between a prebiotic and a probiotic?
- RCDr. Robin Chutkan
A prebiotic is food for the bacteria. So that's typically healthy fibrous foods. Probiotics refer to the actual bacteria themselves, not just the one you're taking as a supplement, but the ones in your gut. So probiotics are bacteria and prebiotics are the food that bacteria eat.
- MRMel Robbins
Got it. And I wanna try to bring in a visual. So if you've ever made bread-
- RCDr. Robin Chutkan
Mm-hmm.
- MRMel Robbins
... and you have that sort of, you're starting it, you've got the yeast and the, and you then feed the yeast with the flour and it starts to bubble, the prebiotic thing is sort of like feeding the yeast-
- RCDr. Robin Chutkan
Absolutely, yeah.
- MRMel Robbins
... and now the, it's like, "Oh, so I'm really hungry-"
- RCDr. Robin Chutkan
Exactly, right?
- 18:52 – 22:34
Three habits you can implement today to build a healthy gut.
- MRMel Robbins
What are the three small habits that you would like us to start implementing into our day-to-day life that are the best things that we could do that will build a healthy, beautiful kind of gut microbiome and get our gut system working correctly?
- RCDr. Robin Chutkan
There are tons of things to do. But if I had to distill it down to three, I would say it's hydration, it's movement, and it's fiber. And the movement, it's smooth muscle. It's not skeletal muscle, so it's not under voluntary control. But we know that movement creates nitric oxide, and nitric oxide is part of what keeps a heart healthy and keeps the gut healthy. And so the movement stimulates peristalsis. If you don't have things moving through in a timely fashion, not only do you have symptoms like bloating and constipation, but you also have stasis of those intestinal contents, and you have bacterial overgrowth 'cause things aren't moving through. So the movement is really important. And I found that since pandemic, so much, so many of us are so sedentary. I know that I'm not at the hospital a few days a week anymore, back and forth where I'm probably walking four or five miles every day. I'm sitting a lot more. And, um, I think we've seen a huge effect of that, of the, you know, effect of being sedentary on the gut. So we need to stimulate gut peristalsis. The people we see with the worst GI problems are people in nursing homes. And it's not because they're elderly. It's because they're not moving.
- MRMel Robbins
Wow.
- RCDr. Robin Chutkan
So movement is really key. Hydration, I can't say it enough times. Plumbing. We've got to unclog those pipes. And then the fiber, because the fiber feeds our gut microbes so they can ferment that fiber, create all the healthy metabolites. And it doesn't have to be like some enormous kale salad. It can literally be grab a carrot as you're walking out the door and chomp on it. Throw an apple in your car. Eat some nuts. Something basic, ideally something unprocessed, right?
- MRMel Robbins
I love how accessible this is, because based on everything that you are teaching us, your body is naturally designed to work in the correct way. It is plumbing. It's trying its best. And so if you drink water, if you get all different kinds of plant-based fibrous foods in, the research says try 30 different types of spices and foods and that, and if you simply walk more, you're saying that that's three things that we can do that will help over time create a healthy gut?
- RCDr. Robin Chutkan
Tremendous benefits. Tremendous. You know, the water thing is, it's like a drug when you really start to... And I was one of those people who for years walked around sorta dehydrated. I mean, I'd drink a lot if I was at heated Vinyasa flow yoga or running, but other than that, I was like, "Ugh, I can't be getting up." I mean, I'm seeing patients. I don't wanna get up every five minutes and have to pee. And then I started measuring and drinking 100 ounces of water. I noticed a tremendous difference. I mean, I already have pretty good poos, I have to say.
- MRMel Robbins
(laughs)
- RCDr. Robin Chutkan
If I can brag. I'll show you some pictures later, Mel.
- MRMel Robbins
(laughs) Oh, my God.
- RCDr. Robin Chutkan
But these th- I mean, just dramatic improvement. And they perk up, like how briskly they come out, because things are lubricated.
- MRMel Robbins
I really do wanna dig into having you help us understand specific gut issues like bloating and IBS and some of the things that people really struggle with. But before we go there, I would love for you to explain to us, why should we care about a healthy gut? And what I'm trying to, to ask is,
- 22:34 – 30:36
This is why your gut health is SO important.
- MRMel Robbins
what is it impacting when your gut is healthy and when it's not? You said earlier that there's a big connection between your immune system and your gut health, which I didn't know. And so if you could just elevate this issue for us at the highest level, like why beyond our plumbing working does your gut health mean total health?
- RCDr. Robin Chutkan
The gut-immune connection is probably the most important connection for the gut and other organs. You have the gut lining, and on one side, you have the trillions of microbes in your gut, your microbiome. And on the other side, you have the immune cells. And that gut lining is only one cell thick. It's a razor blade separating your gut microbiome from the immune processes. And it's a hand-in-glove relationship. They're working together. Literally, the microbes are like the lookouts, and they're like, "Oh, something problematic coming along." They trigger the immune system. In some cases, they actually kick on the lining of the gut. They push on it to trigger the immune processes. It's a physical interaction sometimes. But they signal the immune cells on the other side to say, "Oh, whoa, something big. Here comes Ebola or SARS-CoV-2. You guys need to get ready, mount an immune response, start making antibodies, T cells mobilize."
- MRMel Robbins
Let me just make sure I'm understanding why this matters. Because based on what you're consuming through your mouth that gets processed through this 30-foot tube, your gut is extracting intelligence that mobilizes other parts of your body to help you outside of this tube?
- RCDr. Robin Chutkan
Ye- absolutely. Your gut microbiome directs your immune system.
- MRMel Robbins
It does?
- RCDr. Robin Chutkan
It literally trains it. It t- and that's, this is why we see, there's a fascinating theory called the hygiene hypothesis, and it was developed by David Strachan. He was a epidemiologist in Britain in the 1950s. He did a study of over 17,000 children from birth to adulthood, so over a long period of time, to figure out why w- they were seeing these high rates of autoimmune diseases in England and sort of post-industrial London. And he found that kids who were exposed to more germs, who were living in large households where cousins and siblings were always sneezing and coughing on them, they were immunized because their immune system had been trained at an early age.... how to differentiate between friend and foe, and whether to mount an immune response or not, how high an immune response. Kids who were super clean, who were never sick, they had higher rates of autoimmune disease later on. And Mel, if we look at a map of the world today, we still see the effects of the hygiene hypothesis. We still see high rates of autoimmune disease in countries where there are higher levels of sanitation, there's more washing, there's more chlorination, there are more chemicals, there are fewer microbes, compared to less developed countries, where people have close contact with animals, they have close contact to the soil, they're growing their own food. So, the immune system needs exposure to microbes early on in order to train it, so it can set it at just the right level. What we're seeing now in more developed countries like the United States is we're seeing an overactive immune system, which is manifest as autoimmune disease, one in four Americans, many people have multiple, or allergies, food allergies. Everybody's got an allergy.
- MRMel Robbins
Why? Why do we have a food allergy?
- RCDr. Robin Chutkan
Because of an overreactive immune system. And why do we have an overreactive immune system? Because of what's going on in our gut. There is a very direct correlation.
- MRMel Robbins
Can I... Let me see if I can explain this to myself. So, you're basically saying that when your gut is out of whack and it's getting all kinds of mixed signals because if your microbiomes and the gut health isn't intact, it's actually not able to either break things down or read what's coming in correctly?
- RCDr. Robin Chutkan
Mm-hmm.
- MRMel Robbins
And then that means it is not signal, able to signal in an efficient and effective way to your immune system that either we gotta go into battle or everything are, is okay. And so, because our guts are out of whack, we're not getting the hydration, we're not moving, we're not taking care of ourselves and eating the fibrous foods, this is causing our immune systems to go haywire. And-
- RCDr. Robin Chutkan
Absolutely.
- MRMel Robbins
And i- this is so fascinating, and I actually, I actually read somewhere, I don't know if this is true, that 80% of people that, at least in the United States, that have an autoimmune disorder are women?
- RCDr. Robin Chutkan
Yes.
- MRMel Robbins
Why does this impact women so much?
- RCDr. Robin Chutkan
Very, very high rate. And Gabor Maté talks about this and other folks. We think it may have something to do with the effect of the female hormones, estrogen, progesterone, et cetera, and the interaction with the gut, and also because some of these genetic predisposers for autoimmune disease are sex linked. They're tied to the X chromosome. So, a couple different reasons. I also worry about the personal care products, the cosmetics, the other things that women tend to use more of that are getting absorbed into the body and how those might be affecting women. Because, you know, you think about it, you put makeup on at 10 o'clock in the morning. At 10 o'clock at night, it's like, "Where's the makeup? It's all gone. Where's it gone?" It's got absorbed into our body. And again, I'm not saying that makeup causes autoimmune disease, let's be clear. But we put a lot of things on our skin, and after our GI tract, our skin is our next biggest digestive organ. Our skin literally digests the things we're putting on it. And so, we have to also think, you know, what are we putting on our hair, our skin, et cetera, that could be getting absorbed into our body that could potentially be triggering an immune response? So, that's just one of several theories. And like most diseases, like cancer, like dementia, it's not one cause.
- MRMel Robbins
Right.
- RCDr. Robin Chutkan
It's multiple different factors.
- MRMel Robbins
But is there research or do you see in your clinical practice, if you are doing these interventions that anybody can do, drink more water, move your body, eat more, like, fibrous foods in your diet, when you can start to get your microbiome and your gut health and your plumbing working as it should, do you see an impact on an autoimmune disorder?
- RCDr. Robin Chutkan
Most of what I do in my practice now is helping people with complex autoimmune disorders, like Crohn's and ulcerative colitis, get off immune suppressing drugs. And do you know how we do it, Mel?
- MRMel Robbins
No.
- RCDr. Robin Chutkan
We do it with diet and lifestyle. And if you had told me 27 years ago when I finished my GI fellowship that I would be treating complex autoimmune diseases with food, I would have laughed at you and I would have said, "Ha ha, that's hocus pocus, craziness." But now when I think about it, I think about my colleagues saying to me, "Does that stuff really work?" And I'm like, "Are you asking me, as a fellow gastroenterologist, if what you put into your gut affects what's going on in your gut, and you're asking me is that how it w-" I mean, of course that's how it works. What we put into our gut profoundly impacts what's going on in our gut, and what's going on in our gut profoundly impacts what's going on in the rest of the body. So, it... I mean, it's, it is very contrary to the prevailing wisdom of all the biologics and the immunosuppressants you see advertised on television, and that's a gazillion-dollar industry. But I will tell you, Mel, we have published data on this, and we have a success rate of about 79% getting patients off of these biologic treatments. Now, I will tell you, it doesn't work in everyone and it's a cherry-pick population, because people are coming to see me, fancy GI doc, who, you know, they've gotta travel out, whatever, come and see, and they're motivated, right?
- MRMel Robbins
But the, but the intervention is what anybody could do.
- RCDr. Robin Chutkan
The intervention is what anybody c-
- MRMel Robbins
It's drinking more water-
- RCDr. Robin Chutkan
Oh, yeah.
- MRMel Robbins
It's moving your body.
- RCDr. Robin Chutkan
The intervention is not any, you know, special diet you have to go and buy or products. It is... I mean, we sometimes do use this very high potency probiotic, the one I mentioned that has the indication as a medical food for IBD. We'll often use that in conjunction,
- 30:36 – 34:43
The diet Dr. Robynne prescribes to her patients to get them off medication.
- RCDr. Robin Chutkan
but it's always with dietary change. And I'll tell you, the diet that I put patients on-
- MRMel Robbins
What is the diet?
- RCDr. Robin Chutkan
It's, it's similar to what I eat. It's a green smoothie in the morning, and I tell them, "If you do nothing else..."... do this green smoothie, get in your three leafy greens, a little celery, the parsley and mint are for me just for flavor, fruit, ice, little lemon for taste. Get that in in the morning. And I usually start people on about 12 ounces, and then I work them up to 40 ounces of this green smoothie.
- MRMel Robbins
Okay.
- RCDr. Robin Chutkan
And it's all just stuff you buy at the supermarket. And I-I always felt like I was sort of alone out there in the wilderness, saying, you know, "Eat food, real food. It will make a difference." So, green smoothie in the morning. And I tell people, "Look, if you're still hungry, have some eggs, make an omelet, definitely have something else, for sure."
- MRMel Robbins
Yeah.
- RCDr. Robin Chutkan
And then for lunch, it's usually something based around plants. So, I'll encourage my patients, I'll say, "Get a salad." That's usually easy for people to get.
- MRMel Robbins
Sure.
- RCDr. Robin Chutkan
And if you want some animal protein, go for it, but make sure it's a big salad, and ideally put some chickpeas in there, some hummus on the side. So, lots of plants.
- MRMel Robbins
Okay.
- RCDr. Robin Chutkan
And then for dinner, if you are an animal protein eater, your protein, your starch, your two veg, plus salad. And that's it.
- MRMel Robbins
There's the formula.
- RCDr. Robin Chutkan
It's- it's sort of sensible eating, and it's also getting people to cut down or ideally eliminate the ultra-processed foods, the packaged foods with all the emulsifiers. In my neck of the woods, for autoimmune diseases in the GI tract, we see that the emulsifiers, the soy lecithin, carrageenan, those things are particularly bad for the gut. And we think it's not so much the microbiome, but it's the gut lining-
- MRMel Robbins
Mm.
- RCDr. Robin Chutkan
... that they compromise the gut lining in some way.
- MRMel Robbins
What are some other parts of your overall health that are driven by gut health that might surprise someone to know?
- RCDr. Robin Chutkan
Your estrogen levels. I did not learn this in medical school. When I found this out a decade or so ago, I was mesmerized by something called the estrobolome. And the estrobolome refers to a collection of bacteria in your gut that metabolize estrogen. So, when the estrogen is made primarily in the ovaries and a little bit in the adrenal glands, and it travels through the bloodstream to all the different parts of the body that have estrogen receptors, and that's not just the uterus. That's also heart tissue, different parts of our brain, et cetera, that have estrogen receptors. And then the estrogen that's not used gets transported. It gets into the bile, and it gets excreted into the gut, and it gets recycled through the gut. So, there's certain bacteria in the gut that help to recycle that. Some of it gets excreted out, and some of g- it gets reabsorbed back through the lining into the bloodstream. If the estrobolome is disrupted, you get higher levels of reabsorption than you should. And you end up with a situation called estrogen dominance, where you have too much estrogen on board. And that is associated with a lot of conditions, with fibroids, with endometriosis, with a lot of the menopausal symptoms we think of. And again, this isn't the only reason, for sure, right? But this is... Most people don't realize that the gut plays a huge role in estrogen metabolism. So, if you've been taking antibiotics nonstop for, you know, whatever they may have been prescribed from your t-
- MRMel Robbins
Decades? (laughs)
- RCDr. Robin Chutkan
Exactly. Not, you know, "I had a strep throat. I took antibiotics." But somebody put you on antibiotics for your skin, told you you have a chronic inflammatory condition, maybe rosacea, "Take these antibiotics," or because you're getting frequent urinary tract infections, "Take the antibiotics every time you have sex." And, you know, that could add up, depending (laughs) on who you are. So, so many of the patients I see, and so many women in particular, are put on these suppressive antibiotics, not to treat an actual infection, but to treat inflammation or to prevent an infection, and that ends up being ruinous to your gut bacteria. And that ends up affecting your estrogen metabolism and throwing your estrogen levels off balance. So, I really,
- 34:43 – 37:36
You need to know this about your gut if you’re going through menopause.
- RCDr. Robin Chutkan
particularly for my menopausal women, and particularly 'cause I'm menopausal myself, really focus, really take a gut-centric approach to that, to really look at you've got to have a healthy gut if you wanna go through menopause successfully. And there have been some really interesting articles. Dr. Neal Barnard at the Physicians Committee for Responsible Medicine, and they're very much a plant-based organization, they published a study that looked at a plant-based diet for vasomotor symptoms in menopause, for hot flashes. Way more effective than hormone replacement.
- MRMel Robbins
Wow.
- RCDr. Robin Chutkan
And- and the thing that I find in my patient population is it doesn't have to be a completely plant-based diet. Now, Neal and his colleagues, who are wonderful people, would tell you that it should be. But, you know, we live in the real world, and not everybody's going to become a vegan to control-
- MRMel Robbins
Right.
- RCDr. Robin Chutkan
... their hot flashes. But just eating more plants and eating a plant-based dinner, having your last meal before you go to bed be primarily plants, can help dramatically. If I want to induce a hot flash, I don't have them anymore, but if I want to induce one, I have a porterhouse steak and some red wine at night, and I'm, like, up all night-
- MRMel Robbins
I was just gonna say the same thing.
- RCDr. Robin Chutkan
... up all night.
- MRMel Robbins
I was just gonna say the same thing.
- RCDr. Robin Chutkan
Yeah. Because digestion is such an active process, and particularly digesting animal protein that's high in fat, high in protein, requires a lot of blood flow, a lot of enzymatic activity. That leads to a lot of dilation and flushing. And of course, the alcohol's gonna vi- vasodilate you, too.
- MRMel Robbins
I- I think you just inspired me to make a major change, especially during the weeks that I have, like, a really big workload or-
- RCDr. Robin Chutkan
Yeah.
- MRMel Robbins
... I'm traveling for work, so I gotta get up in the morning, give a big keynote in front of thousands of people. I always think, "Oh, I should have a steak tonight. I should have a piece of fish tonight. I should have a big protein thing to, like, carry me through." And what I'm gathering from you is I would be way better off if I heavy loaded on the leafy greens and the vegetables-
- RCDr. Robin Chutkan
Yes. Yes.
- MRMel Robbins
... and a lot of water at night, because it would allow my gut to just flush itself-
- RCDr. Robin Chutkan
Rest and digest.
- MRMel Robbins
... and allow... Yes.
- RCDr. Robin Chutkan
Yeah. And think about, I mean-... the protein can be sating and it can carry you through, but think about having a high-protein breakfast-
- MRMel Robbins
Yeah.
- RCDr. Robin Chutkan
... the day before. Like, have an omelet the day before or have more protein at lunch, but then for dinner, really lighten it up early and light. Soup and salad, perfect.
- MRMel Robbins
You know, I love this because, uh, so many of the experts that have come on, 'cause we've been talking to a lot of people about hormones and menopause and, uh, for women in particular, how you age well so that you have energy and you're strong and you're able to be, like, vibrant and as you age. And so much of the message is about resistance training and just lots and lots and lots of protein.
- RCDr. Robin Chutkan
Protein.
- MRMel Robbins
Right? And so, I think really trying to get the big protein in the morning and at lunch is the way to go. But I've, uh, like, so I'm, I'm learning so much. Can you
- 37:36 – 39:39
You won’t believe how important the gut-brain connection is.
- MRMel Robbins
explain be- w- the connection between the gut and the brain to the person listening?
- RCDr. Robin Chutkan
The gut-brain connection is another fascinating one. I think gut/immune and gut/brain right now. We have a whole separate nervous system in our gut called the enteric nervous system. And it's many, many millions of nerve cells. In fact, we have about seven times the number of nerve cells in our gut that we have in our spinal cord. Not as much as we have in our central nervous system, clearly, but the gut is a very innervated organ. Lots of n-
- MRMel Robbins
Innervated?
- RCDr. Robin Chutkan
Lots of nerve cells.
- MRMel Robbins
Okay, gotcha.
- RCDr. Robin Chutkan
It also communicates directly with the brain via the vagus nerve, the 10th cranial nerve. Messages going back and forth. The gut also is where most of the neurotransmitters are produced. Serotonin, the feel-good hormone, dopamine, several others. Most of them are produced in the gut. They're co-manufactured by bacteria.
- MRMel Robbins
I think that is a surprise to most people, 'cause you hear the word serotonin and you think brain.
- RCDr. Robin Chutkan
Brain. Yeah.
- MRMel Robbins
But you're here to tell us, Dr. Robin, "No, no, no, no. Your gut health is critical because the serotonin that you need, most of it is manufactured in a healthy gut."
- RCDr. Robin Chutkan
In a healthy gut. So what we see is that with a disrupted gut, we see abnormalities in mood, in cognition, in memory. And conversely, 'cause it's bidirectional, it's gut affecting brain and brain affecting gut, we see the brain influence on gut motility, enzyme secretion, and absorption of nutrients. So you've gotta have it in balance. And, and it's, it's not either/or. It's not either you take an SSRI or you eat healthily. It's both. But the idea that you can, you know, and particularly for young people, the idea that you can take a young person who's struggling with mental health issues and they can be, you know, eating Cheetos and cheeseburgers while you're medicating them and you're not paying attention to what they're eating is magical thinking. We have to pay attention to that for brain health also.
- 39:39 – 44:43
The science-backed connection between anxiety and stomach problems.
- RCDr. Robin Chutkan
- MRMel Robbins
Is there a scientific link between, like, depression and anxiety and gut health?
- RCDr. Robin Chutkan
There are. And like a lot of these conditions, it's multifactorial, but I'll give you just a basic example. There's a bacteria called Campylobacter jejuni, which is a common cause of foodborne illnesses. And sometimes people will get it with a traveler's diarrhea when they're out of town or something. In mice, if you inject a large inoculum of Campylobacter jejuni, you induce anxiety in mice. What's a human correlate for that? Post-infectious irritable bowel syndrome, which is what we refer to when somebody has a change in bowel habits that's happening after an infection, often after an infection like Campylobacter jejuni. Post-infectious irritable bowel syndrome doesn't just affect your bowel habits where now the bowel habits are irregular, maybe they're looser, they're more frequent. It also frequently involves changes in mood. People will say they're more anxious. "You know, I went to the Caribbean, I got traveler's diarrhea." "I was in Mexico, I got Montezuma's revenge and I came back and my bowel habits haven't been the same, but I also find I'm more anxious. My mood seems to have changed." And we think a lot of that is mediated through the change in the microbiome.
- MRMel Robbins
Wow. Let's talk about IBS, 'cause I have a number of friends and family members that are struggling with it. So what should somebody do if they think they have IBS? What would you say, "These are the steps I would take before you go running for some sort of drug"?
- RCDr. Robin Chutkan
Yeah. Number one is you have to figure out what is causing it. And I like to think in terms of general categories. So is it something mechanical? If you're a woman, when was your last ultrasound? Do you have a big fibroid? Could there be endometriosis? Do you have an anteverted uterus or a prolapsed bladder or something that's pressing on it? So what is the anatomical, mechanical thing going on that could be causing symptoms?
- MRMel Robbins
Okay.
- RCDr. Robin Chutkan
Medicine cabinet is a big one, and it's not just prescription drugs, but it's also over-the-counter and supplements. So you need to look at the side effects.
- MRMel Robbins
And what am I looking for?
- RCDr. Robin Chutkan
All of them. You're looking for things that have GI side effects. Nausea, vomiting, diarrhea, constipation. And when-
- MRMel Robbins
Isn't that every medication
- NANarrator
(laughs)
- RCDr. Robin Chutkan
... when they say-
- MRMel Robbins
... right? (laughs)
- RCDr. Robin Chutkan
It, it's a lot, but I'll tell you, when they list side effects, they list the most common ones first. It's like ingredients at a food label, right?
- MRMel Robbins
Okay, yeah.
- RCDr. Robin Chutkan
So the most common ingredient is listed at the top.
- MRMel Robbins
And by common, you mean this is the-
- RCDr. Robin Chutkan
Plentiful.
- MRMel Robbins
... this is the side effect we see the most.
- RCDr. Robin Chutkan
Exactly.
- MRMel Robbins
Okay.
- RCDr. Robin Chutkan
Yes. So if you see nausea, vomiting, abdominal pain, constipation, diarrhea in the top five and, and you are having some of those symptoms, that's something that's worth checking out. And again, not advocating that you take a drug holiday on your own, but talk to the prescriber. And, and here's the thing, your psychiatrist might be prescribing a drug for you for anxiety, and the drug may be helping your anxiety, but it may be causing a whole different problem in the GI tract. I have to remind people that just because something is helpful doesn't mean it's a good idea. And I tell people all the time, "If you're tired and I gave you some cocaine, it would pep you right up."
- MRMel Robbins
(laughs)
- RCDr. Robin Chutkan
"But does that mean cocaine is a good idea for treating fatigue?" So in my practice, I spend so much time...... trying to undo sort of medical misadventure, I like to call it, where a very well-meaning physician prescribes something for his or her neck of the woods, a kidney problem, a psychiatric problem, a lung problem, and it's going great for that problem, but it's messing up my organ now. (laughs) So we're very siloed in medicine. You know, the nephrologist does the kidneys, and the pulmonologist does the lungs, and the- a- and everybody's just sort of focused on their thing. And because the medicine cabinet is such a problem, the GI tract, and, and as you said, Mel, but, you know, don't all these drugs have GI side effects? Many of them do because, you know, you ingest them. So they potentially affect the pH of the gut, they potentially affect the gut lining, and they potentially affect the gut microbiome, and then those things affect the immune system, et cetera. So it becomes a sort of whack-a-mole. Like you whack one problem here, your high blood pressure. Fantastic, well, blood pressure's controlled. Now we have a problem over here. So we whack that with another medicine. And so it's polypharmacy. And when I see people, the first thing I wanna figure out is, is this a side effect I'm treating? Because it often is, right?
- MRMel Robbins
Mm.
- RCDr. Robin Chutkan
So is their constipation or their bloating a side effect of a medication they're taking? And the, the sometimes challenging thing is people don't wanna hear that. They want, like, the magic potion.
- MRMel Robbins
Right.
- RCDr. Robin Chutkan
Like give me the magic supplement probiotic that's gonna make this all go away. So I have people bring their medications, their over-the-counter, the supplements, everything, and I lay 'em all out on the table. And the people in my office always laugh 'cause I always have my rubbish bin right n- next door 'cause they're like, "Oh, this is gonna fill up." And I'm like, "Okay, this one, what's this one for?" And to be clear, I would never tell somebody to stop a prescription medication that I didn't prescribe.
- MRMel Robbins
Right.
- RCDr. Robin Chutkan
I tell 'em, "This one you gotta talk to your prescriber about."
- 44:43 – 49:01
Dr. Robynne wants you to throw away these over-the-counter medications.
- RCDr. Robin Chutkan
left.
- MRMel Robbins
What is kinda the first thing that you're l- like, no. No Advil, no aspirin, no this. Like the thing that people-
- RCDr. Robin Chutkan
You-
- MRMel Robbins
... take all the time?
- RCDr. Robin Chutkan
... you got it. The nonsteroidal anti-inflammatory drugs.
- MRMel Robbins
What is that?
- RCDr. Robin Chutkan
Advil, Anacin, Aleve, ibuprofen. So when we look at the emergency visits for gastrointestinal bleeding, number one cause.
- MRMel Robbins
Too much.
- RCDr. Robin Chutkan
Too much ibuprofen.
- MRMel Robbins
Wow.
- RCDr. Robin Chutkan
People don't realize that over-indexing on this stuff can cause fatal gastrointestinal bleeding. There was not a weekend on call when we were not in the intensive care unit with our scopes trying to stop dramatic, you know, near fatal gastrointestinal bleeding.
- MRMel Robbins
Wow.
- RCDr. Robin Chutkan
So these drugs can be potentially really dangerous. You have to be careful with them.
- MRMel Robbins
Um, and I'm assuming that if this is kind of the detective work you're doing, that it's still the same three things that you would recommend in terms of movement-
- RCDr. Robin Chutkan
Yes, yes.
- MRMel Robbins
... and water and diet-
- RCDr. Robin Chutkan
But it's, it's-
- MRMel Robbins
... to overcompensate.
- RCDr. Robin Chutkan
But you gotta g-
- MRMel Robbins
(clears throat)
- RCDr. Robin Chutkan
You know, it's you can't fill a bathtub with the stopper out, right? So if you're trying to improve gut health-
- MRMel Robbins
Mm.
- RCDr. Robin Chutkan
... fill the bathtub. You have to make sure that it's stopped up, that you're not draining all the good stuff you're doing out. So I like this concept of personalized medicine. But personalized medicine not in the sense of, like, you know, all these wonky tests and supplements, but personalized medicine in terms of sitting down and really figuring out what are the things that you're dealing with and what is a background noise?
- MRMel Robbins
Mm.
- RCDr. Robin Chutkan
What is the platform on which your symptoms or illness-
- MRMel Robbins
Mm-hmm.
- RCDr. Robin Chutkan
... live?
- MRMel Robbins
Mm-hmm.
- RCDr. Robin Chutkan
Is that platform a standard American diet, you know, only eat a broc- a broccoli floret once a week as your only vegetable? Is it massive amounts of antibiotics in childhood, as was the case with my daughter? Is it really sedentary and no time outside? So you've gotta look at that platform, see what you can change, and then start to add on, right? You don't just start adding on all the medication without really... And even thinking about the other medication. How are these four other medications you may be taking for high blood pressure or something else, how are they affecting the liver?
- MRMel Robbins
I, I think this is so amazing because I hope as you're listening to Dr. Robin, you're waking up and realizing, if I can get the three kinda main things right, it probably creates a foundation for better health overall, which helps me sort out what I should be doing and what I shouldn't be doing. So Dr. Robin, here's where I wanna go next. One thing that I wanna talk about with you today is poop, like what should we be looking for, what's healthy, what's not?
- 49:01 – 52:20
How often should you be pooping?
- MRMel Robbins
often should you be going?
- RCDr. Robin Chutkan
How often do you eat? Do you eat every day?
- MRMel Robbins
Of course.
- RCDr. Robin Chutkan
At least once a day?
- MRMel Robbins
Yes.
- RCDr. Robin Chutkan
You should be eliminating once a day. So this idea, we have this textbook definition that it's, you know, three or more bowel movements a week is normal, but if you're going under three, you're constipated. It's a very arbitrary number. And when we think about constipation, we're usually thinking about things like consistency, you know, is the stool hard or is it soft, how much is coming out. But it should absolutely be a daily thing, because that's what it is, it's elimination. It's eliminating dead blood cells, it's eliminating bacteria, toxins, et cetera, undigested food particles. That stuff is not supposed to be gumming up your colon just sitting there, right?
- MRMel Robbins
Everybody that does not go number two once a day just leaned in and thought, "Oh, gosh. Well, what do I do?" So if- if you're somebody that is not going once a day, that doesn't have kind of a satisfying (laughs) experience with this or kind of reliable, what are the first couple steps that you want somebody to do?
- RCDr. Robin Chutkan
I think the first thing, again, is recognizing that this should be daily. Now, that being said, if you skip a day here and there or your traveling schedule's a little bit different, that's nothing to worry about. But how can we help people go every day? So I want people to consider a couple things: What they're putting in, how they're stimulating the gut, and that's primarily with movement, and what they might be doing that's slowing things down, the gut motility. So what you're putting in, you wanna make sure you're putting in enough fiber. You wanna make sure you're putting enough water, liquid. It's plumbing. The GI tract is pipes. In fact, a plumber was at my house one day fixing something and I was standing over him and he kept looking at me and he was like, "Are, you know, are you checking what I'm doing?" I'm like, "No, no, no. We're just in the same business. You just make a lot more money than I do. So I'm just-"
- MRMel Robbins
(laughs)
- RCDr. Robin Chutkan
"... looking at what you're (laughs) doing here." But it's plumbing. It's one long pipe from north to south, about 30 feet long, and things get clogged along the way. And what do you do when your pipe is clogged? Thin liquids, lots of water. So I tell people my rule of thumb, half your body weight in ounces of water as a minimum. And that's just plain water. We don't need electrolytes in it, we don't need flavoring. Those things often are irritating to the gut. So just plain water, half your body weight in ounces of water as a minimum, and that makes a tremendous difference. I can probably solve 50% of the constipation I see in my office just by getting people to hydrate.
- MRMel Robbins
Wow.
- RCDr. Robin Chutkan
And by the way, as you know, great for your skin and everything else, right? So, so many of us are walking around dehydrated.
- MRMel Robbins
So takeaway number one for me already is thinking about your gut system as a 30-foot-long plumbing system-
- RCDr. Robin Chutkan
Yes.
- MRMel Robbins
... that starts with your throat, moves all through your body, and right out the chute at the, you know, at the bottom.
- RCDr. Robin Chutkan
Absolutely.
- MRMel Robbins
And that half of your body weight is what you should be hydrating with, just plain water every day. And as a medical doctor specializing in this, 50% of constipation issues can be solved by simply hydrating correctly?
- RCDr. Robin Chutkan
I mean, it's a generalization, but 50% of the people I see in my office who are bloated and constipated and, you know, things are sluggish, when I get them to really start hydrating, things perk right up. I also wanna point out
- 52:20 – 59:32
Three reasons why women’s and men’s gut health differ.
- RCDr. Robin Chutkan
that the female plumbing system is very different from the male plumbing system.
- MRMel Robbins
Oh, how?
- RCDr. Robin Chutkan
And that's because of three main reasons. So if you have had a colonoscopy, if you're 45 or over you should've had a colonoscopy, and you may have been told, particularly if you're a woman, that you have either a redundant colon or a tortuous colon or a twisted colon. And the reason that's more common in women is because of anatomical differences. So number one, we have a longer digestive tract. Our colons on average are about three to five inches longer.
- MRMel Robbins
Why?
- RCDr. Robin Chutkan
Well, that, w- first of all, it may not seem like a lot-
- MRMel Robbins
It seems like a lot to me.
- RCDr. Robin Chutkan
... like three to five inches-
- MRMel Robbins
Three to five inches-
- RCDr. Robin Chutkan
... and it is a lot.
- MRMel Robbins
Like, if you think five inches, that's like from your rear end to your belly button basically.
- RCDr. Robin Chutkan
Exactly. It is a lot. And that extra length creates more looping and twisting, and so things are more likely to get stuck. And that's one of the main reasons women tend to be so much more bloated and constipated. The reason why is to allow for more fluid absorption during pregnancy. So fluid, the colon does two things. It gets up products of digestion from north to south. Well, it does more than two things, but two big things. And then it also reabsorbs water from the inside, from the stool, through the lining of the colon into the bloodstream. So the reason that women have a slightly longer colon is so that when we are pregnant, we can reabsorb more water through the colon to maintain the amniotic fluid.
- MRMel Robbins
Let me just see if I can extract that so that those of us without your amazing (laughs) medical knowledge and degrees understand this, 'cause I think that's fascinating. So y- did you just say that one of the things that your colon is doing is when the waste is moving through your colon, the colon is actually s- uh, removing water-
- RCDr. Robin Chutkan
Yes.
- MRMel Robbins
... and moisture from the waste matter and recycling that water through your body so that as a woman you can make the amniotic fluid, you can do other things that are part of the reproductive cycle?
- RCDr. Robin Chutkan
100%. And so when, if you were to go up into a colonoscopy as somebody is having a bowel movement, which I don't recommend, (laughs) we like to have the colon cleaned out when we're doing that, what you would see is that when the stool hits the top of the colon-
- MRMel Robbins
Yeah.
- RCDr. Robin Chutkan
... it's liquid.
- MRMel Robbins
What?
- RCDr. Robin Chutkan
It's liquid and it's green. It's bilious fluid. And as it moves through the five to seven feet of colon at the end, the fluid gets reabsorbed so that what comes out at the end is a beautiful Mel Robbins "Stool Nirvana," chocolatey brown-
- MRMel Robbins
(laughs) Oh my god.
- RCDr. Robin Chutkan
... gorgeous. We need to make us some T-shirts for you that say, "I have great poops."
- MRMel Robbins
Oh, my God. I- I don't know if I want people looking in the toilet and going-
- RCDr. Robin Chutkan
(laughs)
- MRMel Robbins
... "That looks like Mel Robbins right there."
- RCDr. Robin Chutkan
(laughs) It's a Mel Robbins special.
- MRMel Robbins
Smiling right back at you. Yes.
- RCDr. Robin Chutkan
So, uh, so at the end you get this chocolatey brown thing. So what, how do you turn liquid green at the top of the colon to solid brown at the bottom? The colon reabsorbs the fluid and all the bacteria that are primarily in the colon, you have bacteria throughout your whole GI tract, but they're concentrated at the bottom. The bacteria get dumped in, the dead bacteria, and the dead red blood cells, and that turns it brown. And so that process happens in the colon. The absorption of nutrients, the vitamin A, D, E and K, the iron, all that stuff gets absorbed upstream in your small intestine. So the function of the colon-... transport the products, reabsorb water, ferment the products of digestion with all the gut bacteria so that you end up with a chocolatey brown stool.
- MRMel Robbins
This is fascinating.
- RCDr. Robin Chutkan
So, the longer colon is just reason number one. Reason number two why we're more bloated and constipated is that we have a deeper, wider pelvis. The female pelvis is called a gynecoid pelvis, and the male pelvis is an android pelvis. What that means is that our colon falls deeper down into the pelvis where it has to compete for space.
- MRMel Robbins
Hmm.
- 59:32 – 1:04:43
The surprising causes of constipation.
- MRMel Robbins
So can you walk us through the things that cause constipation that might surprise people?
- RCDr. Robin Chutkan
It's very similar to the irritable bowel syndrome, to the IBS classification. So, mechanical. Do you have a voluptuous venous colon? Do you have fibroids? Have you had surgery and you have scar tissue? Do you have a prolapsed bladder or rectum? So, what's going on mechanically? Medicine cabinet, I think I beat that horse to death. And then hormones. Do you have potentially undiagnosed hypothyroidism? Do you have, uh... Are you early menopause and now you're more constipated because of that? And remember, perimenopause starts, like, 10 years before you stop having your period, so could it be a hormonal problem? Could it be a physiological motility problem? And the motility is very tied to the composition of the gut bacteria. So believe it or not, antibiotics that you took 10 years ago and affected your microbiome can now be causing your gut to slow down or go too fast, and not function properly.
- MRMel Robbins
I have somebody that I love that is chronically constipated, and, like, will go four or five days, and that is consistently what their experience is.
- RCDr. Robin Chutkan
And what do you think the reasons are? Have you ide- have you done any sleuthing to-
- MRMel Robbins
I have.
- RCDr. Robin Chutkan
Yeah.
- MRMel Robbins
And it's a very healthy person, exercises all the time, has a very clean diet, does not take a l- any... Like, not a lot of medication.
- RCDr. Robin Chutkan
Yeah.
- MRMel Robbins
Young. And I personally think it is an issue with the muscles and, uh, not n- Like, somehow training yourself to clench when you should be releasing.
- RCDr. Robin Chutkan
It's a huge category, and I'm so glad you brought it up because I had overlooked that when we were talking about it. So that-
- MRMel Robbins
Can you describe what this means?
- RCDr. Robin Chutkan
Yeah, th-
- MRMel Robbins
'Cause I think for people that also have a sh- th- you're shy about pooping around people-
- RCDr. Robin Chutkan
It's shy bowel. There... The medical terms are things like anismus, and some of these are pelvic floor issues, and I know you've had pelvic floor people on, but it is tightening when you should be releasing. And what we're talking about here now isn't really a pelvic floor issue. It is a muscular issue, and it's exactly what you said. Shy bowel-...the technical term is parcopresis. It's also called psychogenic fecal retention, and it's classified as a psychiatric problem, but there are some really important physiological things that make me think it's misclassified as a psychiatric problem.
- MRMel Robbins
So could somebody have constipation and you actually have shy bowel?
- RCDr. Robin Chutkan
100%. So common.
- MRMel Robbins
Like, you get in there, and you're so constipated-
- RCDr. Robin Chutkan
Yeah, so common.
- MRMel Robbins
...and you're like, "I gotta, I gotta.
- RCDr. Robin Chutkan
Yeah.
- MRMel Robbins
Why can't I get, like, a, uh..."
- RCDr. Robin Chutkan
So common.
- MRMel Robbins
And then as you're, like, stressing and tensing, you're actually in this almost, like, traumatic response to pooping because you're so stressed about being constipated? Is this, like, a thing?
- RCDr. Robin Chutkan
Well, it's, it's the immediate stress, but more, more so, it is what happened before. So people who tend to hold their poo in.
- MRMel Robbins
Yeah.
- RCDr. Robin Chutkan
So you have to have a bowel movement, but, you know, you're in the subway, and there's not a good bathroom, or you don't have time. You're at the airport, and you're worried that your flight's gonna board without you, or you're at school and the bathroom's gross.
- MRMel Robbins
Yeah.
- RCDr. Robin Chutkan
And there's space between the door-
- MRMel Robbins
Yeah.
- RCDr. Robin Chutkan
...and people can see and hear and smell and, you know, there's noise associated with it. It's one of the most important things for bowel hygiene, is to not have stalls.
- 1:04:43 – 1:06:56
Dr. Robynne’s advice for anyone who has tried everything for constipation.
- RCDr. Robin Chutkan
best advice for people is if you have tried everything for your constipation, you did the fiber and the water and this and that and, and you exercise and you do all these things and nothing is working, consider some of these mind/body practices, whether it's cognitive behavioral therapy or it's internal biofeedback, which is a kind of physical therapy, find a biofeedback practitioner. It could make a huge difference. And the keys for me, one clue is on the rectal exam. I'll say, "Oh, yeah, this person definitely has anismus." And another clue is when somebody says, "I've done all of these things, and not only is it not working, it's making me more bloated." Because the sphincter at the very bottom is tight, and so all the fiber and the water and everything is all backed up right at the back door, but the door won't open.
- MRMel Robbins
So what is the diff- how do you know if you're bloated versus you're just gaining weight?
- RCDr. Robin Chutkan
Yeah. That's a really challenging and sometimes uncomfortable conversation to have with people, but a really useful way to know is to take a tape measure and measure right around your waist, generally just around your belly button, in the morning and at night, every day for about a week. If there is a lot of variation in that number, that's likely bloat, because it, bloating ebbs and flows. And it's usually gas, but it can also be liquid and solid. If it is belly fat, that number typically won't vary by more than an inch.
- MRMel Robbins
Wow.
- RCDr. Robin Chutkan
And sometimes people come and they have an apple shape, skinny legs, big belly, and they think they're bloated, and on exam I can also tell because fat feels different.
- MRMel Robbins
Yeah.
- RCDr. Robin Chutkan
And when you auscultate and you, um, you know, you percuss and tap and you auscultate and listen, I can tell fat from, from, uh, gas. But if somebody's out there and they're not at the doctor measuring the waist and seeing if it ebbs and flows, and people send me pictures, and typically it's fa- it's flat to fat from morning to night. So they're flat in the morning, and then they send me pictures at the end of the day and they're super bloated.
- MRMel Robbins
What are some surprising foods that cause bloat that we might not know cause bloat?
- RCDr. Robin Chutkan
Yogurt.
- MRMel Robbins
Yogurt?
- RCDr. Robin Chutkan
Yogurt. Because somewhere between 60 and 70% of the
- 1:06:56 – 1:14:42
Why many of us lose our ability to digest this as we get older.
- RCDr. Robin Chutkan
world's population is lactose intolerant, and, uh, some people know it because they have really smelly gas and they, you know, it's immediate, but many of us lose our ability to digest dairy over time, because, you know, we're not baby cows-
- MRMel Robbins
(laughs)
- RCDr. Robin Chutkan
...so we're not really meant to be or designed to be drinking this. The lactase enzyme is along the brush border in the small intestine, and, and if you have an acute infection, that can knock it off and you lose it, and just as we age over time. So people might have tolerated dairy really well and now they're not, or their dairy would mostly be cheese and yogurt and things that, that don't have as much lactose. They're not drinking big cups of milk. But dairy is one that a lot of people think of as a health food, and it can be, right? It's a fermented food and so on. But so often, people are not tolerating the dairy, and so they're having all this yogurt every day-It's a convenient, quick, portable, delicious source of protein. So many of my patients, I'll see some form of dairy, either yogurt or cottage cheese. They're trying to get their protein up every day and we get rid of that, things improve a lot.
- MRMel Robbins
Ah.
- RCDr. Robin Chutkan
So that's something to... And not for everyone-
- MRMel Robbins
Right.
- RCDr. Robin Chutkan
... but for a lot of people, it's dairy.
- MRMel Robbins
Are there some surprising everyday, non-food things that can cause you to be bloated?
- RCDr. Robin Chutkan
Yes. There are. Um, one of the things to remember with bloating, I mean, we think about the GI tract and elimination and stool and liquid and gas, but it's also our lymphatic system. And our lymphatic system i- is like a fluid that bathes our cells and it has to drain. And exercise is what stimulates lymphatic flow, so if you're sitting for a long time-
- MRMel Robbins
Mm.
- RCDr. Robin Chutkan
... and you may notice it just, if you're sitting for a long time, your feet swell.
- MRMel Robbins
Yeah.
- RCDr. Robin Chutkan
Well, why do your feet swell?
- MRMel Robbins
I don't know.
- RCDr. Robin Chutkan
Because the venous flow, the veins are occluded because you're sitting and there's pressure on the veins and the lymphatics don't move as much. So moving around, exercise, really important for the lymphatic flow, really important for de-bloating. And then there's things like salt in the food, alcohol. And alcohol's a big one because it irritates the gut, that can lead to inflammation, that can lead to fluid retention. It also dehydrates us and then that causes fluid to shift and puffiness, things like that. But, um, exercise is another big one for bloating.
- MRMel Robbins
When somebody comes and sees you, Dr. Robin, and they just are really, really bloated and it's not a big serious issue, it is something that they're experiencing, is there, like, kind of like a step-by-step protocol that you're like, "Do this and do this and you should be feeling relief in a matter of days"?
- RCDr. Robin Chutkan
I love putting people on a liquid diet for a couple of days and using some magnesium citrate. Now, I wanna say with the magnesium citrate in the liquid, the bottle, you gotta make sure there's no kidney disease and other things going on. But let's say this is a typical, healthy person. They went on vacation. They over-sported themselves, in the words of my (laughs) mother-in-law. They ate a little too much, they drank a little too much, they... You know, they... Most of us come back from vacation feeling a little constipated.
- MRMel Robbins
Why is that? It's because we've just been like, "Woo-hoo!"
- RCDr. Robin Chutkan
It's because we've been woo-hoo, and also if we've crossed time zones that we often feel jet lag in our gut. It slows down. And also because our GI tract is a creature of habit.
- MRMel Robbins
Mm.
- RCDr. Robin Chutkan
So, you know, now you're in a strange bathroom somewhere and so w- our bowels get a little shy when we're traveling. So my favorite thing in that situation is to put them on two days of a clear liquid diet, which could be broth and tea and green juice-
- MRMel Robbins
Mm-hmm.
- RCDr. Robin Chutkan
... as opposed to a smoothie, and do that for a couple of days and a little bit of liquid magnesium citrate at night. Not too much.
- MRMel Robbins
What's a little bit?
- RCDr. Robin Chutkan
We don't wanna blast things. Well, a t-
- MRMel Robbins
Like a teaspoon?
- RCDr. Robin Chutkan
No, no, no. The typical bottle of magnesium citrate is about a soda bottle, so maybe a quarter of that.
- MRMel Robbins
A quarter of it, okay.
- RCDr. Robin Chutkan
A quarter of that, so like a cup-
- MRMel Robbins
Okay.
- 1:14:42 – 1:17:59
“The Gut Bliss Method,” Dr. Robynne’s 10-day plan for a better gut.
- MRMel Robbins
it?
- RCDr. Robin Chutkan
The Gut Bliss Method consists of removing, replacing, and restoring. So the first part is to remove foods, practices, medications that are potentially harmful to your diet. So that would be things like ultra-processed foods, alcohol, nonsteroidal anti-inflammatory drugs, and, uh, excessive antibiotics. And for practices, it may be something as simple as not taking enough time to have a bowel movement. So removing those things. And the idea behind that is kind of like the bathtub. If you're gonna fill the bathtub, you gotta make sure the stopper is in. You don't wanna be trying to fill a bathtub with the stopper out because you're eating foods, taking medications that are still causing a problem. So that's remove. Replace is trying to add in those extra healthy bacteria, not through a probiotic primarily, but through exposure to nature, through fermented foods that we talked about, the powerhouse combination of pre, pro, and postbiotics, and those sorts of really healthy high fiber and fermented foods to replace the gut bacteria. And then the restore is how do you restore overall health? And a lot of that focuses on mi- mind-body practices, on getting outside, on getting quiet, reducing stress, and of course hydration is a big part of it. So it's simple. It's stuff that anybody can do. It's not expensive. I mean, you need access to some good food and you need to actually eat it. But what I find, whether I'm seeing a patient who has complicated Crohn's disease or somebody who's just a little bloated, it is incredible how much of a difference these basic principles make. And I came up with them over, it's been a couple decades of practice. And not to say that some of the fancier things don't play a role also, right? But what I find the majority of the time, it's really getting people to pay attention to these foundational things that they can do. These are not things that require a gastroenterologist. I mean, you may need to go to the gastroenterologist for the evaluation for sure, particularly if you have alarm symptoms. But these are things that anybody can build into their everyday routine, and I know that it, you know, it doesn't sound super sexy. "Well, where's the fancy, you know, magical food and supplement?" But believe me when I tell you, Mel, I have done thousands of colonoscopies, seen thousands of patients in the 30 plus years since I graduated from medical school, and these are the things that make a difference. And the beautiful thing is you can see a difference quickly. You may not be able to reverse your autoimmune disease quickly, if that's part of the goal, but in terms of that tangible return on investment that your gut is gonna give you when you sit down and you have that stool nirvana for the first time and you're like, "Damn, is this what it's supposed to feel like?" Like, "I just detoxed in the most profound way."
- MRMel Robbins
I freaking love you. I feel so smart and I literally wanna go to the bathroom now-
- RCDr. Robin Chutkan
You are so smart. (laughs)
- MRMel Robbins
... and just like enjoy having a poo. I would love, Dr. Robin, for you to talk directly to the person listening, because you have been so generous and have poured into us. There was so much that you taught us, that you equipped us to be able to do. If there
- 1:17:59 – 1:20:14
The one thing Dr. Robynne wants you to implement TODAY.
- MRMel Robbins
was one thing that you really want them to remember that they walk away and that they implement today, what would that be?
- RCDr. Robin Chutkan
Eat more plants. Eat more plants. You don't have to be vegan or vegetarian or any of it, but plant fiber is the most important food for our gut microbiome. It doesn't mean there are not other things that aren't helpful and it doesn't mean the other stuff you're eating is bad, but we have to feed our microbiome. We have to nourish and nurture it, and we do that with plant fiber. Whether it's just a carrot stick as you're going out the door or an apple that you throw in your bag or it's more complicated, you know, lentil bowl, eat more plants.
- MRMel Robbins
You know, Dr. Robin, I often remind everyone that, um, some of the best people that you will meet, you haven't met yet. And I just love you.
- RCDr. Robin Chutkan
I just love you too. (laughs)
- MRMel Robbins
I feel like you literally walked into my life and we are gonna be lifelong friends.
- RCDr. Robin Chutkan
And for the record, you were already super smart before I walked in here.
- MRMel Robbins
Aw.
- RCDr. Robin Chutkan
You already knew so much stuff. People need to understand how their body works. We're kind of alienated from our body, and we're really alienated from our gut. We don't even wanna look in the toilet. I'm like, "How can you not look in the toilet?" It's like tea leaves. Like, it's telling you something. This is really important evidence and feedback.
- MRMel Robbins
Yeah.
- RCDr. Robin Chutkan
Like, you can't just flush it and ignore it. And we do that because we still have this sort of Victorian sensibility about cleanliness and stool and it's dirty. And so really understanding how this stuff works, and for me, helping people to understand, and this is really the focus of the last book, The Antiviral Gut, that yes, our gut is a digestive organ and digesti- digestion is really important, but our gut is also a defensive organ.
- MRMel Robbins
Mm.
- RCDr. Robin Chutkan
Stomach acid isn't just there to digest food. It also kills pathogens. Our gut lining literally protects us from pathogens so that bacteria and viruses can't penetrate and get into our bloodstream and travel to the rest of our body. Our stool eliminates not just waste matter, but toxins. So there's a huge defensive element to our gut, and if we wanna stay healthy-... we gotta keep these defenses going. We gotta protect these defenses and understand them. So, I'm so grateful to have a chance to come on and-
Episode duration: 1:24:24
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