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

Order your copy of The Let Them Theory 👉 https://melrob.co/let-them-theory 👈 The #1 Best Selling Book of 2025 🔥 Discover how much power you truly have. It all begins with two simple words. Let Them. — If you’ve ever wondered whether your bloating is normal, what your poop is supposed to look like, or why your stomach seems to have a mind of its own… you are definitely not the only one. This conversation is hilarious, science-backed, and packed with the answers to questions we all have but rarely ask. By the end, you’ll understand your body better, feel less embarrassed about what it’s doing, and finally have a practical guide to taking care of your gut instead of guessing. Today, Dr. Trisha Pasricha is here to answer every question you’ve been too embarrassed to ask out loud. Dr. Pasricha is a Harvard Medical School physician-scientist, a board-certified gastroenterologist, director of the Institute for Gut-Brain Research at Beth Israel Deaconess Medical Center, and the longtime “Ask a Doctor” columnist for The Washington Post. She’s also the author of the new book You’ve Been Pooping All Wrong. She’s funny, brilliant, and completely unafraid to talk about the things most doctors avoid, from poop and bloating to hemorrhoids, colon cancer risk, and the surprising ways your gut influences your mood and brain. In this episode, you’ll learn: -What a normal poop looks like and when you should go to a doctor -Why you’re bloated and what to do about it -Why looking at your phone on the toilet dramatically increases hemorrhoid risk (and the 5‑minute rule every GI doctor follows) -The #1 mistake make that causes constipation -Why more young people are getting colon cancer, and the early warning signs of colon cancer you should never ignore -What your gut is telling you about your stress and mental health -The simple habits that support digestion, gut health, and long-term wellness This is the ultimate no-shame conversation that will help you finally understand how to listen to your gut. Dr. Pasricha will change the way you think about digestion, gut health, and yes, even poop. For more resources related to today’s episode, click here for the podcast episode page: Follow The Mel Robbins Podcast on Instagram: https://www.instagram.com/themelrobbinspodcast I’m just your friend. I am not a licensed therapist, and this podcast is NOT intended as a substitute for the advice of a physician, professional coach, psychotherapist, or other qualified professional. Got it? Good. I’ll see you in the next episode. In this episode: 0:00 Meet The Guest 4:59 Digestive System Explained: How Digestion Works 13:20 Stress and Stomach Pain: Why Anxiety Causes Gut Symptoms 19:24 What Is a Gut Feeling? The Science Behind Trusting Your Gut 26:20 Why Gut Health Problems Are Increasing: What Doctors Are Seeing 32:08 Chronic Constipation: Symptoms, Causes, and Treatment Options 38:06 Gut Symptoms You Should Not Ignore: When to See a Doctor 40:40 Colon Cancer Warning Signs: The 4 Symptoms to Take Seriously 48:16 How Often Should You Poop? What’s Normal vs. Not Normal 49:44 What Shape Should Your Poop Be? 54:29 Is It Bad to Hold in Poop? Side Effects Explained 59:37 Poop Color Guide: What Color Should Your Poop Be? 1:11:20 Why You Should Never Bring Your Phone In The Bathroom 1:15:19 How to Wipe Properly: Toilet Hygiene Tips That Work 1:20:34 Gut Health Myths: Leaky Gut, Bloating, Probiotics, and Supplements — Follow Mel: Instagram: https://www.instagram.com/melrobbins/ TikTok: http://tiktok.com/@melrobbins Facebook: https://www.facebook.com/melrobbins LinkedIn: https://www.linkedin.com/in/melrobbins Website: http://melrobbins.com​ — Sign up for Mel’s newsletter: https://melrob.co/sign-up-newsletter A note from Mel to you, twice a week, sharing simple, practical ways to build the life you want. — Subscribe to Mel’s channel here: https://www.youtube.com/melrobbins​?sub_confirmation=1 — Listen to The Mel Robbins Podcast 🎧 New episodes drop every Monday & Thursday! https://melrob.co/spotify https://melrob.co/applepodcasts https://melrob.co/amazonmusic — Looking for Mel’s books on Amazon? Find them here: The Let Them Theory: https://amzn.to/3IQ21Oe The Let Them Theory Audiobook: https://amzn.to/413SObp The High 5 Habit: https://amzn.to/3fMvfPQ The 5 Second Rule: https://amzn.to/4l54fah

Dr. Trisha PasrichaguestMel Robbinshost
Mar 30, 20261h 32mWatch on YouTube ↗

EVERY SPOKEN WORD

  1. 0:00 – 4:59

    Meet The Guest

    1. TP

      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.

    2. MR

      40%?

    3. TP

      15% of Americans have irritable bowel syndrome. Three out of four Americans can't poop in a public restroom. One out of three struggle to go to the bathroom on vacation.

    4. MR

      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 gonna 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. Trisha 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?

    5. TP

      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.

    6. MR

      Okay, now here's a question.

    7. TP

      Yeah.

    8. MR

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

    9. TP

      I'm so excited. [laughs]

    10. MR

      [laughs] 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 wanna make sure you don't miss a thing, and I'm so glad you're here for this episode, 'cause this is a really good one. All right. Let's dive in. Dr. Trisha Pasricha, I'm so excited that you are here.

    11. TP

      Thank you so much for having me, Mel.

    12. MR

      Oh, my gosh. All right. We are gonna dig into this. I cannot wait. I, I really can't wait to talk about poop. I, I know that, that we're gonna get into that a little bit later, but, um, 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?

    13. TP

      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 gonna change for you is that you're gonna 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 gonna share with you today. And once you have that knowledge and that validation, it's gonna give you power back and agency to get the help that you need.

    14. MR

      Wow. So Dr. Pasricha, let's just start with the basic level. What is the gut specifically?

    15. TP

      Yeah. Let me bring out this model here.

    16. MR

      Okay.

    17. TP

      Let's walk through it.

    18. MR

      Okay, so she's pulling out... Okay, now, uh, we're all in medical school, everybody.

    19. TP

      [laughs]

    20. MR

      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 gonna 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 our intestines. But Dr. Pasricha is gonna really narrate this for us.

    21. TP

      Yeah, and first thing I'm gonna do is actually I'm gonna take the lungs out. [laughs] I'm gonna take the heart out just so we can see-

    22. MR

      Okay

    23. TP

      ... a little better, although I promise you I'm not that heartless.

    24. MR

      [laughs] No pun intended.

    25. TP

      [laughs] So-

    26. MR

      Okay, so now I'm seeing... Whoa, what am I seeing?

    27. TP

      Yeah,

  2. 4:59 – 13:20

    Digestive System Explained: How Digestion Works

    1. TP

      so this, what I'm gonna 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.

    2. MR

      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.

    3. TP

      Yeah.

    4. MR

      I think about the part that swells. I think about the part that hangs out over my pants.

    5. TP

      Yeah.

    6. MR

      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-

    7. TP

      Yep

    8. MR

      ... it's the mouth and all the things that connect your mouth all the way through until it goes out the other side.

    9. TP

      That is the entirety of the gastrointestinal tract. So everything that's part of that really, really long, complicated tube, that's your gut.

    10. MR

      Huh.

    11. TP

      Mm-hmm. So let's walk through it. So suppose you take a bite of food. It goes through your mouth here.

    12. MR

      Yep.

    13. TP

      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.

    14. MR

      Okay.

    15. TP

      And it goes from the esophagus down.

    16. MR

      You know what's interesting?

    17. TP

      Yeah.

    18. MR

      I don't know if you feel this way-As you're listening to this episode right now, but I've always thought the esophag- es- the esophagus-

    19. TP

      Yeah

    20. MR

      ... actually goes down the front.

    21. TP

      Yes.

    22. MR

      Like in front of-

    23. TP

      Not so.

    24. MR

      Do you see what I'm saying?

    25. TP

      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.

    26. MR

      It's behind the heart?

    27. TP

      Yeah, it's in the back of your chest.

    28. MR

      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.

    29. TP

      Yeah. When you get heartburn-

    30. MR

      Yes

  3. 13:20 – 19:24

    Stress and Stomach Pain: Why Anxiety Causes Gut Symptoms

    1. TP

      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.

    2. MR

      Enteric nervous system?

    3. TP

      Enteric nervous system.

    4. MR

      Okay.

    5. TP

      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.

    6. MR

      So Dr. Pasricha, there's, you know, you- 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.

    7. TP

      Yep.

    8. MR

      But can you talk about the science and when researchers and medical experts realized there is a two-way communication and how that connection gets formed in a person?

    9. TP

      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.

    10. MR

      Mm-hmm.

    11. TP

      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 ha- 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 a, I sometimes feel cramps in my stomach.

    12. MR

      Sure.

    13. TP

      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 fri- flipped the script.

    14. MR

      What does it mean to you that 80% of the messaging begins in our guts telling our brain something?

    15. TP

      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.

    16. MR

      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.

    17. TP

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

    18. MR

      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.

    19. TP

      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-

    20. MR

      Yes

    21. TP

      ... 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. HoweverOnce 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.

    22. MR

      And even if it's not the actual source, it certainly is contributing to the extent to which the symptoms feel even worse.

    23. TP

      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 and 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.

    24. MR

      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 gonna 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.

  4. 19:24 – 26:20

    What Is a Gut Feeling? The Science Behind Trusting Your Gut

    1. MR

      So from a medical standpoint, when I say, "I have a gut feeling"-

    2. TP

      Yeah

    3. MR

      ... or, "I've got butterflies in my stomach," what does that mean? Like, what's the science behind that?

    4. TP

      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 the bathroom-

    5. MR

      Why does that happen?

    6. TP

      ... like, right now, right?

    7. MR

      Yes, why does that happen? Why do I always have to pee or go number two right before I'm about to give a speech, or I'm about to, or I'm about to walk in here-

    8. TP

      [laughs]

    9. MR

      ... and do an interview with you? Which, like, why do I have to go to the bathroom right now?

    10. TP

      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.

    11. MR

      Yep.

    12. TP

      Right? And so the heart beats at this regular rhythm of 60 beats per minute or so. Well, it turns out your stomach is, actually has its own rhythm, and it's contracting at a regular rate of about three beats per minute. But what I found is that when you're telling a lie, that regular rhythm of three beats per minute, it goes into total chaos. It doesn't contract anymore at three beats per minute. It enters this chaotic rhythm called 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, and which is this: the gut can respond to external information s- 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.

    13. MR

      Ah.

    14. TP

      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-

    15. MR

      Ah

    16. TP

      ... 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.

    17. MR

      Great.

    18. TP

      So suppose you're a leader in your group, and someone's presenting a new proposal, and that proposal sounds great on paper, and everyone in the room, they're nodding along. They like it. You suddenly get this tightening in your gut. Popular culture would say, "Ah, that's a gut feeling. It's a bad gut feeling. There's something off about this proposal."

    19. MR

      Yes.

    20. TP

      "You should reject it."

    21. MR

      Yes.

    22. TP

      And maybe the proposal's horrible. I'm not sure. But I think it would be premature to say that. What you should wonder and consider is, what if you're getting a gut feeling that's responding not to some inherent risk, but to novelty? What if this proposal is challenging your way of thinking in a way you've never done before? Maybe that's a wonderful thing.

    23. MR

      I love this idea that, 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.

    24. TP

      That's right.

    25. MR

      There's something that I need to pay attention to. What's the second example?

    26. TP

      Well, suppose we're on a date.

    27. MR

      Yes.

    28. TP

      And you've met this new man-

    29. MR

      I love what you're-

    30. TP

      ... or this new woman

  5. 26:20 – 32:08

    Why Gut Health Problems Are Increasing: What Doctors Are Seeing

    1. MR

      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?

    2. TP

      Yeah. Well, here's a number that made me realize that we have a gut health crisis hiding in plain sight: 40%.

    3. MR

      40%?

    4. TP

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

    5. MR

      Okay, I wanna just dig in there just a little bit.

    6. TP

      Please.

    7. MR

      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 i- i- 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, 'cause I th- 'cause 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- 'cause now all the big tests that everybody's doing to figure out your-

    8. TP

      Yeah

    9. MR

      ... full longevity and all this stuff, you gotta poop in a dish and scoop it out and all. 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-

    10. TP

      Yeah

    11. MR

      ... are dealing with this. 15% of people have IBS. Three out of four people cannot go number two in a public bathroom.

    12. TP

      Yeah.

    13. MR

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

    14. TP

      Yeah, and we're at work, what, 8, 12 hours a day? I mean, think about how many- [laughs]

    15. MR

      Now, is... I, I, and I think most of us think it's psychologicalBut I don't... Maybe it's not. And I th- I think it's insane that one out of three 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 seven days since I've gone number two."

    16. TP

      100%. Yeah. Well, I-

    17. MR

      Okay, so let's talk about the... Like, what is... Is it data? Like, how, how, how... Why is this important when it comes to gut health?

    18. TP

      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 kinda like getting a little report card on your health.

    19. MR

      [laughs]

    20. TP

      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.

    21. MR

      Okay.

    22. TP

      I find it so odd when I ask my patients, "Well, what did your poop look like?" And they say, "Well, I don't, I don't look."

    23. MR

      I think they're lying.

    24. TP

      [laughs]

    25. MR

      E- even to you, as the doctor.

    26. TP

      Like, what are we here for then, you know? And so, like, you have to look. Um, 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.

    27. MR

      Okay.

    28. TP

      The color, we're gonna get into. That gives you a lot of information. How you felt, make note of that. [laughs] 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.

    29. MR

      What do you wanna say to somebody who

  6. 32:08 – 38:06

    Chronic Constipation: Symptoms, Causes, and Treatment Options

    1. MR

      has chronic constipation, and they're a clencher, about the reality of that this might... 'Cause w- 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 f- all of a sudden felt bad as a mom because I'm thinking about those diapers that you change-

    2. TP

      Yeah

    3. MR

      ... where y- your sweet little baby's there, and you're like, "Ew, what is this? This is, like... Oh, my gosh. Mustard poop. This feels terrible." And so our reaction to it-

    4. TP

      Yes

    5. MR

      ... also creates this, like, embarrassment and shame around something that's so normal.

    6. TP

      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 times a year, and they're like, "Hey, did you do two minutes each side? Make sure you get your gums. Are you getting the back of your tongue?" Who's asking you what you do when you shut the door to have a bowel movement after you're done potty-training? Nobody's checking in. And it's so common, right, that I have patients who come to my clinic, 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 five minutes.' And they know it's gonna be 60 minutes later that they come out." And what I wanna 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 one in three, which is so common.

    7. MR

      That's 33%.

    8. TP

      Mm-hmm.

    9. MR

      There, there are four of us in this studio right now.

    10. TP

      Well, there should be four of us with constipation. Four of us with constipation, then [laughs] it's gonna be-

    11. MR

      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.

    12. TP

      Absolutely right.

    13. MR

      That's incredible.

    14. TP

      And the beauty of it is, un- 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 eight to 12 weeks is what the studies have shown, that 80 to 90% of people get better. But if you wanna know a quick fix-

    15. MR

      Yes

    16. TP

      ... if you're not ready for the PT-

    17. MR

      Yes

    18. TP

      ... what one really important study found is that one out of six people who seem to have pelvic floor dysfunction like this, one out of six, the entire problem could be solved just by raising their knees above their waist when they had a bowel movement, using something like a stool, a stack of books, a pair of nice stilettos. Raise their knees above their waist.

    19. MR

      Nice stiletto- [laughs] I'm gonna put my heels on and go g- go number two, Chris.

    20. TP

      [laughs] It'll help.

    21. MR

      Yes. Well, you know, it's funny you say that because our, our, every time our, our adult kids are home-

    22. TP

      Mm-hmm

    23. MR

      ... I walk into my own bathroom, and the garbage can is right in front of my toilet-

    24. TP

      Yep

    25. MR

      ... 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-

    26. TP

      They're onto it

    27. MR

      ... of that actual-

    28. TP

      Yeah

    29. MR

      ... that actual, the mechanics of the knees being up.

    30. TP

      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.

  7. 38:06 – 40:40

    Gut Symptoms You Should Not Ignore: When to See a Doctor

    1. TP

      Yeah. One of the most common things that people come to my clinic complaining about is that they struggle to have a bowel movement.

    2. MR

      Uh-huh.

    3. TP

      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."

    4. MR

      How long should it take?

    5. TP

      "It's uncomfortable." Less than five. Ideally, less than one minute.

    6. MR

      Okay.

    7. TP

      It should be an in-and-out job.

    8. MR

      Wow.

    9. TP

      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.

    10. MR

      Ugh.

    11. TP

      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 bath- and have to do it now. There are a lot of people, one out of seven people, okay, I wanna just internalize this number. One out of seven people poop their pants regularly in America. That's what the studies have shown.

    12. MR

      Wow.

    13. TP

      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.

    14. MR

      Huh.

    15. TP

      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 f- like, you, 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 and depression. Certainly a lot of them, stress fuels these problems-

    16. MR

      Oh

    17. TP

      ... and makes them worse. But oftentimes it's not the stress that's the primary problem.

    18. MR

      Mm, or the anxiety or the depression.

    19. TP

      Exactly.

    20. MR

      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

  8. 40:40 – 48:16

    Colon Cancer Warning Signs: The 4 Symptoms to Take Seriously

    1. MR

      help us address it. What gut sy- symptoms should you never ignore because they signal that something bigger could be happening?

    2. TP

      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 four most common symptoms of early onset, meaning before the age of 50, colorectal cancer? But these also apply to colorectal cancer at any age. Okay, and so these four symptoms are, one, abdominal pain, two, rectal bleeding, three, iron deficiency 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-

    3. MR

      Oh

    4. TP

      ... you're tired, you get the blood test, oftentimes people will say, "This has to be due to your period," 'cause 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 kinda 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, 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 three or four of the four symptoms I just mentioned, they had a sixfold higher likelihood of having colorectal cancer than people who had fewer.

    5. MR

      Sixfold?

    6. TP

      Sixfold.

    7. MR

      So you've got stomach cramps.

    8. TP

      Stomach, abdominal pain.

    9. MR

      Abdominal pain. You have bleeding from your rear end.

    10. TP

      Yep.

    11. MR

      You have iron deficiency.

    12. TP

      Yep.

    13. MR

      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?

    14. TP

      Yeah. I, I would go get help for any of these symptoms no more than one or two weeks if it's persisted.

    15. MR

      Wow.

    16. TP

      And, 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're 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.

    17. MR

      Dr. Pasricha, why do you think there is this very troubling trend of so many young people not only getting but dying of colon cancer?

    18. TP

      Yeah. It's, it's a 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. Now, obviously, our genetics aren't changing, but what can change with generations is something called epigenetics-

    19. MR

      Oh

    20. TP

      ... 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.

    21. MR

      Yeah. Don't you think it's ultra-processed foods-

    22. TP

      Ultra-

    23. MR

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

    24. TP

      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.

    25. MR

      Are, is, is the rise in colon cancer in younger patients, is that higher in a country like the United States, where we have, like, horrible regulations when it comes to ultra-processed foods?

    26. TP

      It's a global trend, and that's what's really worrisome.

    27. MR

      Okay.

    28. TP

      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 Nurse's Health Study.

    29. MR

      Right.

    30. TP

      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 and 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-

  9. 48:16 – 49:44

    How Often Should You Poop? What’s Normal vs. Not Normal

    1. MR

      and what is not normal when it comes to poop?

    2. TP

      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.

    3. MR

      What does that mean, socially appropriate?

    4. TP

      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, that, 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.

    5. MR

      Okay, and what is that range?

    6. TP

      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 three times in one day to once every three days is in the range of normal.

    7. MR

      Okay.

    8. TP

      So if you fall in that happy, comfortable range, I am really happy for you if you're comfortable.

    9. MR

      Okay.

    10. TP

      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 gonna start to have fluffier, more frequent bowel movements. It's not gonna be once a day, and you should embrace that new you. It's okay.

  10. 49:44 – 54:29

    What Shape Should Your Poop Be?

    1. TP

      Let me show you a couple models.

    2. MR

      Okay.

    3. TP

      Okay.

    4. MR

      Oh my God.

    5. TP

      Right here.

    6. MR

      Okay. Now, if you're listening, uh, she is hold... Dr. Pasricha is holding up poop. But I, but I have to give a shout-out to our team-

    7. TP

      Oh my God

    8. MR

      ... because our team-

    9. TP

      Creative geniuses

    10. MR

      ... ordered Play-Doh, and I cannot believe how realistic this is. It's almost I can, can smell it. On the right, you're seeing a log [laughs] that is... This is embarrassing.

    11. TP

      [laughs]

    12. MR

      You're re- you're seeing a log that's maybe, it's like a bratwurst. It's, like, about the-

    13. TP

      Yeah

    14. MR

      ... 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, the other one, 'cause there's two here, is about four inches long, but the, 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-

    15. TP

      Yeah, a little torpedo

    16. MR

      ... a torpedo.

    17. TP

      Yeah.

    18. MR

      Okay.

    19. TP

      Yeah. I think what you're descri- First of all-

    20. MR

      Could you move-

    21. TP

      ... beautiful description

    22. MR

      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 gonna narrate. If you wanna 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, um, you know, Mel Robbins and Dr. Pasricha. There we go.

    23. TP

      You know, I think most people would consider this type of bowel movement to be normal-

    24. MR

      Isn't it?

    25. TP

      ... 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.

    26. MR

      So is that, uh, is that what you would consider... Is the smooth torpedo shape-

    27. TP

      Yeah

    28. MR

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

    29. TP

      This is, this is a lovely poop.

    30. MR

      So these are n- these are good. You're giving this an A.

  11. 54:29 – 59:37

    Is It Bad to Hold in Poop? Side Effects Explained

    1. TP

      rabbit pellets, and felt like they had a good poop.

    2. MR

      Never.

    3. TP

      Yeah.

    4. MR

      They're not satisfying. If you just drop a couple of those in, you're like, "I'm not done. I'll be, be, I, hopefully I'll be back here in an hour or two," but this is just, that's not even an appetizer. Like, that's-

    5. TP

      That's a C minus.

    6. MR

      Okay, yes.

    7. TP

      Yeah, I don't know if you're gonna pass, but-

    8. MR

      What, what is that telling you?

    9. TP

      It-

    10. MR

      When you have those little, like, you know, it's like beep, beep, and you're like, "That's it?"

    11. TP

      Yeah. It can tell us one of two things.

    12. MR

      Okay.

    13. TP

      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 gonna hold it until tomorrow," well, the poop that you need to have tomorrow is gonna look very differently than the poop you would've had today because you've held it in, and now more and more water is gonna get sucked out, and it's gonna look differently.

    14. MR

      So if you're a person-

    15. TP

      Mm-hmm

    16. MR

      ... you're one of those, you said, Dr. Pasricha, that three out of every four people do not go number two at work.

    17. TP

      Yeah.

    18. MR

      If you're somebody that is clenching-

    19. TP

      Yep

    20. MR

      ... all day at work, which could be 10 to 12 hours, you gotta be in your own bathroom.

    21. TP

      Yeah.

    22. MR

      Are you causing yourself to have harder poop because you're not allowing your body to just do what it needs to do?

    23. TP

      Yeah. I mean, when you feel that call, that's usually your body's way of saying, "Hey, I'm helping you. I'm doing some of the work right now." Your muscles are contracting. It is providing you the propulsion. If you ignore that call, and this is why, I mean, one of the most fundamental things I teach people is, don't ignore the call. Go. Bring some nice bathroom spray with you if that's what 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-

    24. MR

      Oh

    25. TP

      ... and harder valsalva, by straining.

    26. MR

      Because it's sucked all the water out of it.

    27. TP

      And now you are looking at a different poop than you had 12 hours ago. It was already gonna be hard. It's gonna be way harder now.

    28. MR

      Huh. And what is the one on top that is kind of in a log shape, but it's, like, hard pellets together?

    29. TP

      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.

    30. MR

      Oh, I hate those, 'cause they come out in chunks. I hate those.

  12. 59:37 – 1:11:20

    Poop Color Guide: What Color Should Your Poop Be?

    1. TP

      Okay, so you wanna talk about color?

    2. MR

      Yeah, let's talk about color.

    3. TP

      All right. So I've got a set of Pantone color cards for you, okay, Mel?

    4. MR

      Okay.

    5. TP

      I'm gonna hand these over to you.

    6. MR

      Okay. Okay. Yep, I got-

    7. TP

      Have a look at them.

    8. MR

      Yes.

    9. TP

      These are colors that people have actually told me they've seen in their poop before. So I want you to-

    10. MR

      Oh

    11. TP

      ... flash them over to me.

    12. MR

      Wow.

    13. TP

      And let's talk about-

    14. MR

      Okay

    15. TP

      ... if they're normal or not normal.

    16. MR

      All right. All right. I'm gonna describe them.

    17. TP

      Yeah.

    18. MR

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

    19. TP

      Ooh, and it-

    20. MR

      Okay?

    21. TP

      ... kind of matches my s-

    22. MR

      Yes

    23. TP

      ... doesn't it?

    24. MR

      That to me looks like the kinda diarrhea a baby has after-

    25. TP

      Yeah

    26. MR

      ... they've had breast milk.

    27. TP

      Yeah. I mean, this is a lovely bucolic shade. I would say, first of all, Mel, everyone's ar- allowed to have a weird colored poop every now and then.

    28. MR

      Well, that's, that, that... If I saw that as an adultI would think something's very wrong.

    29. TP

      If you see this shade, it's a little bit green, maybe a little yellow, and you have other symptoms, like for example, you have 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.

    30. MR

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

  13. 1:11:20 – 1:15:19

    Why You Should Never Bring Your Phone In The Bathroom

    1. MR

      you talk about the 5-minute toilet rule. What is that?

    2. TP

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

    3. MR

      If you're in there for five minutes, you've got your knees up on the stool, or feet up on the stool-

    4. TP

      Yep

    5. MR

      ... you're trying to relax into it, and nothing's happening, just pull up the pants and come back later?

    6. TP

      Yeah. And this is really hard because we're all in there with our smartphones, right?

    7. MR

      Yes.

    8. TP

      And the reason this is important, last year I did this study in my lab where we looked at people coming in for their screening colonoscopies. And so we're taking a look directly with our eyes, with our scope, to see what's going on in their bodies, and we asked them right before they went in all about themselves. How long do you spend in the bathroom? Do you take your 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 five times as likely to spend more than five minutes at a time in the bathroom, and they are at a 46% increased risk of having hemorrhoids. We saw them-

    9. MR

      Oh-

    10. TP

      ... with our eyes.

    11. MR

      You're kidding me.

    12. TP

      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. So I'm 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's 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.

    13. MR

      Holy cow.

    14. TP

      Mm-hmm.

    15. MR

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

    16. TP

      Yep.

    17. MR

      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.

    18. TP

      Ugh.

    19. MR

      And it was a whole-

    20. TP

      [laughs]

    21. MR

      [laughs] I- i- 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-

    22. TP

      [laughs]

    23. MR

      ... already in the house. [laughs] This is normal? People get these things? Um, and so, [laughs] you have to put that up there? What? And so [laughs] I, [laughs] a hemor- I always thought a hemorrhoid was, like, irritation of the skin-

    24. TP

      Yeah

    25. MR

      ... from something, but you're saying it's actually the veins around your exit-

    26. TP

      Yeah

    27. MR

      ... that are filling?

    28. TP

      It's just your body, but yeah, it's, you know, there's two kinds of hemorrhoids. [laughs]

    29. MR

      Okay.

    30. TP

      All right? So there's 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 s- hemorrhoids. Those are the kinds that you can feel, and they're the really bothersome ones. They 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.

  14. 1:15:19 – 1:20:34

    How to Wipe Properly: Toilet Hygiene Tips That Work

    1. TP

      couple days.

    2. MR

      Now, Dr. Pasricha, you also talk about being very intentional about toilet paper.

    3. TP

      Yes.

    4. MR

      Which seems weird, but you say it matters a lot. Why?

    5. TP

      Yeah. Well-

    6. MR

      'Cause I, I... 'Cause my, my husband and I have this fight, 'cause I think there's two types of toilet paper. There's a type that's stiff and, like, abrasive-

    7. TP

      Yeah

    8. MR

      ... and that frankly feels kinda 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-

    9. TP

      Yeah.

    10. MR

      So, 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?

    11. TP

      I think what you're talking about is the difference between two-ply, which is this guy.

    12. MR

      Two-ply.

    13. TP

      And then one-ply.

    14. MR

      Yeah, puffy and thin.

    15. TP

      I-

    16. MR

      Expensive, cheaper. [laughs]

    17. TP

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

    18. MR

      I do.

    19. TP

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

    20. MR

      Okay.

    21. TP

      Okay. I am worthy.

    22. MR

      I am worthy. [laughs]

    23. TP

      I am enough.

    24. MR

      I am enough.

    25. TP

      I deserve two-ply toilet paper.

    26. MR

      I deserve two-ply toilet paper.

    27. TP

      I mean, look at this. This is one-ply. All right? This is pathetic. You don't need this on the most delicate part of your body, and that's your 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-

    28. MR

      Ooh

    29. TP

      ... inside their bathroom, you gotta run for the hills.

    30. MR

      That's a red flag.

  15. 1:20:34 – 1:31:59

    Gut Health Myths: Leaky Gut, Bloating, Probiotics, and Supplements

    1. MR

      what are the biggest gut health myths that social media is pushing that you're just like, "I am so sick of seeing this"?

    2. TP

      Yeah. There's two big ones for me. One is leaky gut.

    3. MR

      Okay.

    4. TP

      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.

    5. MR

      Yep.

    6. TP

      But different things happen throughout the day that cause the junctions between the cells to just slightly open up. When they open up, other cells can travel through, back and forth, chemical signals can move. That's happening to all of us. We have 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 in 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-

    7. MR

      Oh

    8. TP

      ... 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 does.

    9. MR

      Okay.

    10. TP

      It has been implicated in irritable bowel syndrome and, 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?"

    11. MR

      [laughs]

    12. TP

      "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-- 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, 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's real, but because that's not the root cause.

    13. MR

      Oh.

    14. TP

      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 three-step supplement that will fix your leaky gut." And actually, what you wanna ask yourself is, what is it about my lifestyle that might be increasing intestinal permeability? N- 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-

    15. MR

      Oh

    16. TP

      ... 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 gut, that is 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.

    17. MR

      Really?

    18. TP

      I know. I know. It comes as a shock 'cause you always see, like, "Recommended by most gastroenterologists," or, "All gastroenterologists recommend." That's not the case. It's not because I'm gonna tell you if you've come to me and you, you've been taking this probiotic for years that you've loved, you digest better, you poop now once a day easily, that your probi- probiotic is not working. It could be working.

    19. MR

      Mm.

    20. TP

      But we don't have enough robust data to say in whom it's always gonna work consistently that we can make a good recommendation for it and feel ethical about doing that. Here's the thing that I think people don't understand about the microbiome.

    21. MR

      Yep.

    22. TP

      So if you think about your microbiome as a garden-

    23. MR

      Uh-huh

    24. TP

      ... and y- 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.

    25. MR

      Yep.

    26. TP

      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 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-

    27. MR

      Oh

    28. TP

      ... 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, 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? Have I had vegetables? Have I eaten something fermented?" And sometimes that's the way that you can nudge the ba- the bacteria populations in your gut one way or another.

    29. MR

      Amazing. Now, Dr. Pasricha, as a, a neurogastro researcher and medical doctor, what is one thing that you stopped doing that has had a huge impact on your gut health?

    30. TP

      I stopped pretending like I was gonna get enough fiber through my diet. And I'm a gut health research- researcher, like you said, and, um, I think about my gut health, like, way more than most people. And so I thought for a really long time that I should, I have to get all my fiber needs, which for women over 50 is 21 grams per day, for under 50, 25 grams per day, that I should get it through my diet, that I should be, like, making these beautiful bento box lunches with, like, this colorful different, like, five different vegetables and fruits. And, um, it would happen for me, like, several days a week, and then it just, like, wouldn't. I have two kids. I have, like, three jobs. I'm just a normal person who's trying to get through the grocery store cereal aisle like everybody else. [laughs]

Episode duration: 1:32:00

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