Can you trust your gut? with GI doctor Trisha Pasricha | ReThinking

1. 0:00 – 0:37

   Gut feelings are real signals—but don’t label them too fast

   1. TPTrisha Pasricha0:00

      A gut feeling has a true physiological basis. I think the way we get it wrong though is that we take that gut feeling and then we say, "Okay, this gut feeling is good," or, "This gut feeling is bad," and we assign some value to it. But if you jump to label it too quickly, I think we can get this entirely backwards. [upbeat music]

   2. AGAdam Grant0:21

      So this is, this is an unusual conversation for us, and definitely for me. And I can't believe that we're doing it without children present because this is a topic that every kid loves, but I think there are some things that I need to rethink based on this conversation. So-

   3. TPTrisha Pasricha0:37

      [laughs]

   4. AGAdam Grant0:37

      [laughs]

2. 0:37 – 2:37

   Digestion begins in the brain: how thoughts rev up your gut

   1. AGAdam Grant0:37

      Le- let me just ask you to start at the top, Trisha. Where does digestion actually begin? I've always thought about it as something that happens, like, in the gut via the mouth.

   2. TPTrisha Pasricha0:47

      Yeah. I think that's how most people think about it. Digestion begins in the brain, and we've known that digestion begins in the brain for a very long time. And in a way, the gut is unlike so many other organs that our brain, and our thoughts, and our feelings can so strongly influence what our gut is doing. There's almost no other organ where the main thing, one of the main things it does can be completely controlled by your thoughts, right? Like, your heart is gonna keep on beating. You might think about a scary movie and you can kinda get it to ramp up, but it's not gonna fundamentally change what it does. Whereas, like, right now if you or I picture this, like, nice, warm, gooey chocolate cake, and you can picture that chocolate sliding down the plate, like, soon you might start salivating. And actually, your pancreas is gonna start secreting insulin, and your whole gut starts to rev up purely because of your thoughts. And that is something that we had observed even as far back as, like, Ivan Pavlov in that ex- famous experiment with his dogs. But it really is those set of experiments that birthed this whole field called neurogastroenterology, which is the study of the gut-brain connection, and that's what I study, and that's what I am now. Um, and it's an exciting field because we now know how deep that connection is between the gut and the brain.

   3. AGAdam Grant2:04

      Okay, so this bothers me as a psychologist because whenever people say, "Trust your gut," I, I have a few reactions. The first one is, no, test your gut because I don't know where you got your gut instincts-

   4. TPTrisha Pasricha2:17

      [laughs]

   5. AGAdam Grant2:17

      ... and whether they're valid in the situation you're in or not. But secondly, I, I prefer to trust my brain. Like, that's where I do my cognitive processing, and I'm afraid you're gonna tell me it's a little more complicated than that.

   6. TPTrisha Pasricha2:29

      Well, I'm with you that I don't necessarily jump to trust my gut either, which may also be surprising as a gastroenterologist.

   7. AGAdam Grant2:37

      [laughs]

3. 2:37 – 5:19

   The physiology of a gut feeling: stomach rhythms, stress hormones, and “arrhythmia”

   1. TPTrisha Pasricha2:37

      I'm sure all my GI colleagues are like, "How dare she? The gut is the superior organ." And you know, let me just say that I think what we consider to be gut feelings in pop culture has taken on almost, like, a role of, like, an oracle. Like, your gut can predict the future, it can tell you the way things really are in a way that your brain may not be able to tell you. And this is something I've studied really, really closely for more than 20 years, and a gut feeling has a true physiological basis. And this is something that I studied when I was in high school, and I developed a lie detector that could use your stomach to detect when somebody's telling the truth versus telling a lie. And physiologically what I found is actually a little bit boring and a little bit simple, and that is this: Your gut actually contracts at a predictable cycle just the way your heart contracts at around 60 beats per minute, give or take, is for your heart. For your stomach, it's about three cycles per minute. And when you tell a lie, that cycle gets completely disrupted. It goes into this chaotic rhythm called arrhythmia. And physiologically, that rhythm and that rhythm disturbance, which starts in the brain, is being driven by this molecule called corticotrophin-releasing hormone, and it comes through the bloodstream, and it immediately tells your stomach to halt and stops it from emptying. And if you think about it that way, what's cool is that it means that your gut is often quickly responding to some change, some threat, some excitement that your amygdala is processing, sometimes maybe before your conscious brain in your head has pieced together why. And so your stomach can be this first herald of, like, "Wait, there's something off about this environment." It can be, like, for example, I used to be a theater kid. If I blew my lines on stage, I would get this, like, sinking feeling in the pit of my stomach, right? Or maybe it's butterflies when you're on a date. We know, we all intuitively know what I'm talking about when we talk about that gut kind of feeling. I think the way we get it wrong, though, is that we take that gut feeling and then we assign some value to it. And I usually tell people, like, if we just think about what is happening physiologically, that change in your gut's rhythm which is giving you that gut feeling, that true gut feeling, it's not an oracle. It's just a message, and that message is just that you need to slow down. You shouldn't act on it immediately, but just think, "What is it about my environment that my conscious brain may not have perceived yet, but that I understand?"

   2. AGAdam Grant5:06

      I love that. That, I mean, that, that's a really elegant physiological explanation of why I don't want people to blindly trust their gut instincts.

   3. TPTrisha Pasricha5:15

      [laughs]

   4. AGAdam Grant5:15

      Because you're right, there, there is a message, but the message has to be deciphered.

4. 5:19 – 7:35

   Decoding the signal: butterflies, novelty, and the “safe can feel boring” trap

   1. TPTrisha Pasricha5:19

      Yeah, exactly, and it has to be translated in the context of everything you know. I mean, the amygdala in popular science, it, it gets a little bit dumbed down into saying, like, "Oh, this is the fear processing hub," and it's really, like, a more of an emotional processing hub. And, and sometimes what you're reacting to is not some fear or some deep-seated concern, but it actually might just be the novelty of a situation that you're not used to. And then conversely, you know, Adam, I've seen the other thing happen, and this is very classic. You say you go on a date, and you're with someone new, and then you don't get that butterflies in your stomach with that person, you know? And then, and then I have, I've had girlfriends come to me and be like, "Oh, we didn't have that spark. You know, like, my gut was telling me, like, th- I didn't, I didn't have it." And, like, sure, maybe this person is not the right person for you. Very valid. Um, however I don't think you should make that decision based on whether you had butterflies in your stomach, whether you had a gut feeling about it right then and there, uh, without understanding the bigger context of why, because maybe you didn't have that gut feeling because again, physiologically there was nothing unsettling about this experience. Like, it might have actually just been a person with whom you felt very safe and comfortable. Is that such a bad thing, you know? And I think maybe you need another date or two to know, is he really boring or is he really just like a nice person that you're, you feel happy with.

   2. AGAdam Grant6:30

      And your next date should be structured more like The Bachelor or Bachelorette.

   3. TPTrisha Pasricha6:34

      Obviously. [laughs]

   4. AGAdam Grant6:34

      You're going bungee jumping, right?

   5. TPTrisha Pasricha6:36

      [laughs] God, only, if only.

   6. AGAdam Grant6:38

      This reminds me of, of something that happened in grad school. Um, I, uh, I, I invited a bunch of people to a, I think it was a Valentine's Day gathering.

   7. TPTrisha Pasricha6:48

      Nice. Bold.

   8. AGAdam Grant6:48

      And afterward, one of the attendees, um, gave me feedback that a guy there had creeped her out.

   9. TPTrisha Pasricha6:54

      Oh, gosh.

   10. AGAdam Grant6:55

       And I was really s- I was surprised and disappointed, and I asked her why, and she said, "You know, I can't locate it, but there was something about his eyes that just gave me a bad feeling. I, I knew I couldn't trust him." And I said-

   11. TPTrisha Pasricha7:09

       Hmm

   12. AGAdam Grant7:09

       ... "You know he's gay, right?" And she was shocked-

   13. TPTrisha Pasricha7:11

       [laughs]

   14. AGAdam Grant7:11

       ... because she thought he was hitting on every woman there.

   15. TPTrisha Pasricha7:15

       Oh.

   16. AGAdam Grant7:15

       And it turned out that he, there was something about his eyes that reminded her of a creepy guy that she'd known, and the dots hadn't connected until that moment.

   17. TPTrisha Pasricha7:23

       Classic example. And obviously, you know, they weren't meant for each other anyway, but like [laughs] goodness.

   18. AGAdam Grant7:31

       [laughs]

   19. TPTrisha Pasricha7:31

       That is exactly what we can happen. I think when we just ju- we jump to a conclusion.

5. 7:35 – 10:18

   Why “trust your gut” feels so compelling—and how memory bias fuels it

   1. AGAdam Grant7:35

      You know, it's, it's interesting to me when we, like when we talk about the role of the gut in decision-making. I wanna build on your oracle observation a little bit. Why do you think people are so eager to trust their gut?

   2. TPTrisha Pasricha7:47

      Yeah, I, I think it's for a couple reasons. Like, one, I think it is the first place that we respond emotionally in a lot of places, and that's something that we've known intuitively since we were kids. Like children, when they're feeling sick or where they're feeling nervous, they feel it in their stomach. They'll say, "I have a tummy ache." That's often the first place they feel- And that, again, very physiologically valid. We know how stress, how different kinds of emotional triggers can ch- cause these real changes. And so it does feel like you, you might put this all together and say, "Yeah, my gut is this oracle. It knows." And I also think that in some ways the gut is a little mysterious, right? And, and I do love it for that, and I think the more I learn about the gut, the more I know we don't know. Um, but historically people have thought that the gut... This was Hippocrates who said, "All disease begins in the gut." A lot of people think that all, a lot of our problems in health and, and in life can begin and end in the gut, so it does take on this, like, meaning greater than, than the organ that it is. And again, I'm not downplaying the gut. I'm like on team gut here. But I, I think that there's a lot of misunderstanding and maybe even oversimplification about what the gut does.

   3. AGAdam Grant8:54

      Yeah, that, that resonates, and I wonder if there's also a memory bias at play here, where it really eats at us when we had a, a bad gut feeling about something and we ignored it, whereas-

   4. TPTrisha Pasricha9:05

      Yeah

   5. AGAdam Grant9:05

      ... I think it's, it, it's unforgettable when, you know, when you have this gut instinct, "Do not trust this person," and then they end up-

   6. TPTrisha Pasricha9:12

      Yes

   7. AGAdam Grant9:12

      ... screwing you over because you didn't listen to your gut, um, or, you know, interrogate where is that feeling coming from. And that sends a very strong message to change the next time. But the message is not, "I should always trust my gut." It's that I should, you know, I should do something with that information as opposed to just disregarding it-

   8. TPTrisha Pasricha9:30

      Yeah

   9. AGAdam Grant9:30

      ... as we were talking about a moment ago. And I wonder if the times when we trust our gut and things don't work out are more easily dismissed or don't stick out in our memory as much.

   10. TPTrisha Pasricha9:40

       This is human nature. We're always gonna remember a little bit of the times we got burned more than I think a little bit of, like, the factors surrounding how we ended up as happy as we did. You know, like, when they do these studies, they look back and they say, like, "Yeah, people tend to remember the past and like with a, a rosier lens," and that's often the case. But I think when it comes to moments of trauma, trauma can really reshape and rewire us, especially if that trauma occurs earlier on in our lives.

   11. AGAdam Grant10:06

       The other piece of this that I'm curious about is there's a seductive appeal of, "Well, well, I don't have to, I don't have to do the analysis. I don't have to reason my way through this decision because my body will know and it will tell me."

6. 10:18 – 13:34

   Discomfort isn’t always danger: when intuition helps vs. misleads

   1. TPTrisha Pasricha10:18

      Yeah. You're getting this immediate feedback in the moment and, you know, and again, I, I do think that what is causing, what that trigger of that physiologic change in the gut that changed the electrical rhythm, it's often discomfort. I often tell people discomfort is not inherently bad. Sometimes what pushes you, what makes you uncomfortable can be an incredibly good thing. It can be a really good challenge, and just reframing that feeling of discomfort being bad to discomfort is novel, discomfort is why do I feel this way, can really open up your mind to say like, "Maybe what I'm experiencing right now is not a bad sign. There's actually no prior memory that is resembling this moment, but I'm adding that layer on and I'm imagining that and, and putting all of this stuff that, that's actually not there."

   2. AGAdam Grant11:04

      Yep. I think that, that tracks. It reminds me of a paper by Eric Dane and Mike Pratt. They study gut feelings in terms of intuitions, and they look at whether you can trust your intuition or not when you're making decisions and predictions. And it turns out you can if you're, uh, either an expert or somebody with a lot of experience in a predictable domain. So if you, for example, are an avid shopper, you can trust your gut about whether a handbag is counterfeit or not, whereas if-

   3. TPTrisha Pasricha11:38

      Yeah

   4. AGAdam Grant11:38

      ... you're a novice, you can't because you don't have the years of experience informing that subconscious pattern recognition process. But a lot of our decisions aren't like that. A lot of our gut feelings happen in domains where we don't have a lot of experience or there's not a stable pattern and, and that's where I just want people to, to question. Like, what is this signal coming from? And h- am I just uncomfortable because I'm in an unfamiliar environment?

   5. TPTrisha Pasricha12:04

      I often find that people put a lot of value on gut feelings during big life moments for which, like, none of us have a ton of experience. And so then we're like, we are looking for other signs from the universe telling us this is good or bad. And, and maybe that is, like, things like romantic encounters. Maybe it's, like, taking a leap in a business venture. Like, situations that you might only do a couple times in your whole lifetime. And that's absolutely the moment where if you were an expert, like, this would be wonderful. You'd have all of that background. But if you're not the expert, the message is, let's pause and let's think about what this situation is telling me.

   6. AGAdam Grant12:39

      I guess I wanna put then, like, blindly trusting your gut in the same category as looking for answers in, in the stars. [laughs]

   7. TPTrisha Pasricha12:47

      [laughs] It's almost like that.

   8. AGAdam Grant12:47

      It seems very objective, but it's not valid.

   9. TPTrisha Pasricha12:51

      It's coming from a place of, like, you do wanna pay attention. Like, what... You want to pay attention to what's happening, what's triggering that feeling, and sometimes the cue to that feeling is not fully external. Like, it's important to even understand, am I being internally triggered too from something that is playing out in my mind that's causing these thoughts, for which there's nothing about the environment or the risks or the stakes that are, that are actually the issue. The issue is my own biases that I'm bringing to the table. So it is, there is something that's pulling this, this reaction to your gut, but, but I agree. It's like, you know, it's, it's [laughs] like not quite as bad as astrology maybe, but it's like, it's getting there.

   10. AGAdam Grant13:29

       Okay. So that is a great segue to the lightning round. Are you ready?

   11. TPTrisha Pasricha13:32

       Ooh. I'm so ready.

7. 13:34 – 15:29

   Lightning round: probiotics skepticism and everyday gut-protective habits

   1. AGAdam Grant13:34

      Worst GI advice you see given regularly.

   2. TPTrisha Pasricha13:37

      It would have to be probiotics. And this comes as a surprise, because I think most people assume based on the marketing that gastroenterologists everywhere love probiotics. We do not recommend probiotics for most conditions. The truth is that the data is far murkier, far less profound than you would be led to believe. And I find it really concerning when people are spending hundreds and hundreds of dollars on these probiotics. They're probably not getting the benefit they think they're getting, and they're focusing their attention on that rather than on the interventions that we know are better studied. So probiotics are, like, my big thing.

   3. AGAdam Grant14:12

      Wow. All right. What's your best advice GI-wise?

   4. TPTrisha Pasricha14:15

      Best advice would be to treat your gut like a brain. Like, if you were gonna go bike riding, there's no way that your mom would let you do that without a helmet, right? We protect our brain so aggressively, but we throw any old thing in our stomachs. Like, we wouldn't want to cross the blood-brain barrier, you know? But it actually is hitting that brain. So you would wanna eat a high-fiber diet. You would wanna prioritize sleep. You would wanna prioritize exercise. Eating fewer ultra-processed foods, eating more whole foods. Those things are great for your brain, but they're also the same things that help protect your, help protect your gut. So it's not, it doesn't have to be over-complicated once you start to think about it that way.

   5. AGAdam Grant14:52

      What's something you've changed your mind about recently?

   6. TPTrisha Pasricha14:54

      Well, I will say this is, like, the biggest frame shift in all of GI. I used to think of cancer as a disease of older people, and if, like, a young person came to me and they were like, "I've, you know, I st- I've started having new diarrhea," even if I've seen blood in my stool, I would've said, "Okay, let's, you know, like, look, may- is this irritable bowel syndrome? Are these hemorrhoids?" I wouldn't be thinking about cancer in a 20, 30-year-old. Today, I'm thinking about it. It's not, you know, most likely it is not what is happening, but it is a huge change in how I think, and I think about how all of us have been practicing.

8. 15:29 – 16:22

   GI dinner party picks: Pavlov, flatulence research, and family mentorship

   1. AGAdam Grant15:29

      And you get to organize, uh, the world's greatest GI dinner party.

   2. TPTrisha Pasricha15:34

      [laughs]

   3. AGAdam Grant15:34

      To talk about the gut with anyone alive or dead, who are you inviting?

   4. TPTrisha Pasricha15:38

      Oh, this is so good. Uh, Ivan Pavlov is making that cut. He's getting on the list. Um, Michael Levitt, Dr. Michael Levitt, was the father of flatulence research.

   5. AGAdam Grant15:50

      [laughs]

   6. TPTrisha Pasricha15:51

      If you don't know anything about him, you gotta Google him, and, and not just Google him, PubMed him. If you read the methods of his studies, you'll have so much respect-

   7. AGAdam Grant15:59

      [laughs]

   8. TPTrisha Pasricha15:59

      ... for the scientific process, and, like, you can understand why anyone who loved fart jokes as a kid should become a gastroenterology researcher.

   9. AGAdam Grant16:07

      [laughs]

   10. TPTrisha Pasricha16:07

       So he would totally make the list. And then I'd probably include my dad. He's like, he's like, uh, just the funniest guy I know. He's a neurogastroenterologist. He's a researcher, and he's just got a very keen way of, like, pulling the threads together. So those three.

   11. AGAdam Grant16:20

       Sounds like fun.

   12. TPTrisha Pasricha16:22

       [laughs]

9. 16:22 – 20:07

   Office hours: helping women be believed about chronic pain in gut-brain disorders

   1. AGAdam Grant16:22

      All right. Office hours time. Do you have a puzzle, problem, or question for me?

   2. TPTrisha Pasricha16:27

      Yes. Thank you. I have two. Okay? Um, and this is really, this first one is really relevant to my world in studying disorders of gut-brain interaction. And so one of the main things I, I study is something like irritable bowel syndrome or diseases that don't even really have a name. They're just characterized by pain, by chronic pain in situations where the testing is normal. And this most often, these d- diseases happen more often in women. And women's pain, this is true in my field, it's true in all of medicine, it's just, it's statistically undertreated, it's disbelieved more often than men's. And so from a psychology standpoint, what I would love you to tell me is how to give women more of a concrete toolkit to advocate for themselves and being taken seriously by their doctor, who I think a lot of people in the medical community are quick to tell women to just not believe them and tell them this is all in their heads. Like, how do we convince someone that someone's suffering is real?

   3. AGAdam Grant17:28

      Wow. Well, I have two reactions.

   4. TPTrisha Pasricha17:30

      [laughs]

   5. AGAdam Grant17:30

      The first one is this, this should not be on women. This should be on medical professionals.

   6. TPTrisha Pasricha17:35

      Right. Yes.

   7. AGAdam Grant17:36

      Period, right? So let's, like, let's change medical education to do a better job recognizing this bias and then counteracting it. I don't think that helps the average female patient overnight. So I think in the meantime, you're talking about a fundamental gap in empathy, right? Of-

   8. TPTrisha Pasricha17:53

      Yes. Exactly

   9. AGAdam Grant17:53

      ... a failure to be able to, to imagine somebody else's experience. And one of the ways that we, we close those gaps in psychology is we Like, we, we try to give people, um, a more concrete look or direct sense of what the other person is experiencing. And so, um, I think comparisons could be really helpful there. This hurts more than when I broke my foot or when I delivered a baby.

   10. TPTrisha Pasricha18:19

       Yeah.

   11. AGAdam Grant18:19

       Like, uh, if you can put this on a relative scale and calibrate it against something that the, the provider can relate to, maybe it's a little harder to dismiss if you make it concrete that way.

   12. TPTrisha Pasricha18:29

       I love that.

   13. AGAdam Grant18:29

       So maybe, maybe we need better pain scales that say, okay, zero is, you know, this is somebody poking you in the arm. Um, you know, a 10 is this is somebody amputating your arm. And then let's anchor, [laughs] like, let's anchor each number on an imaginable form of pain that people have really lived. If you then give a seven and the seven is, you know, is anchored to stepping on a Lego.

   14. TPTrisha Pasricha18:54

       Ugh, that is really bad. That sucks.

   15. AGAdam Grant18:55

       Seven is stepping on a Lego. That really hurts. If [laughs]

   16. TPTrisha Pasricha18:58

       Yeah

   17. AGAdam Grant18:58

       ... if somebody, if somebody says to a physician, "This hurts more than if I just stepped on a Lego," I think it's hard not to pay attention.

   18. TPTrisha Pasricha19:07

       I love this because, uh, we have... Pain scales is, like, so embedded in our culture. Like, if a patient comes in with pain, we're like, "Okay, where is it on a zero to 10?" And they'll give a number, and the problem is that, yeah, we have our own subjective bias of what a 10 is. It's different from this person's 10.

   19. AGAdam Grant19:22

       Yes.

   20. TPTrisha Pasricha19:22

       But if you were to say, "It's a seven, and my seven is this," and then you give this concrete example. I've actually never heard it portrayed that way, and, like, I think that would be helpful. You know, when I talk to my residents and they're like, "Oh, this person said they're a 10 out of 10, but, like, they were sitting on their bed relaxed. Like, I'm not worried." And I say, no, that if someone's saying it's 10 out of 10, then we have to take that at face value, and we have to act on it. But I think it's adding a little more nuance to that so that someone else can say, "This is really what that feels like."

   21. AGAdam Grant19:49

       This is relevant to something we talked about when we talked about taste, uh, last year, which is when I tell people that I, I don't like chocolate, they don't get it. When I tell them-

   22. TPTrisha Pasricha19:57

       Mm-hmm

   23. AGAdam Grant19:57

       ... I would rather eat dirt than eat chocolate-

   24. TPTrisha Pasricha20:00

       [laughs]

   25. AGAdam Grant20:00

       ... "Oh, okay, you must really hate it."

   26. TPTrisha Pasricha20:03

       That's how bad.

   27. AGAdam Grant20:03

       Yeah, I think we need to do the-

   28. TPTrisha Pasricha20:04

       Yeah

   29. AGAdam Grant20:05

       ... same thing for pain. Okay, what's your other question?

10. 20:07 – 22:05

    Office hours: changing minds about health misinformation—process over conclusions

    1. TPTrisha Pasricha20:07

       Okay, my other question, something I've seen, we've all seen since the pandemic and even before that, is that health misinformation, it really sticks with people. And it spreads in a way that selling facts just don't seem to do. And so doctors often struggle when they're just seeing one-on-one a patient who believes something is false. What are the tools that you think actually help change somebody's mind about health information and if you have, like, five minutes to do that?

    2. AGAdam Grant20:37

       Yeah, it's, it-

    3. TPTrisha Pasricha20:37

       That's a big question, right? [laughs]

    4. AGAdam Grant20:38

       Yeah, it's not easy. Uh, David McRaney m- wrote a great book that covers a lot of the relevant research. It's called How, How Minds Change. I also love Switch by the Heath brothers, and those would be my, my two go-to resources on this topic. I think in terms of specific recommendations, one thing is, you know, not immediately trying to make the other person feel like an idiot [laughs] is always helpful.

    5. TPTrisha Pasricha20:59

       Yeah. That feels like a good foundation, yes. Love it.

    6. AGAdam Grant21:02

       Yes, and, and saying, "Hey, you know, I, I really appreciate the fact that you came in here with a lot-

    7. TPTrisha Pasricha21:07

       Mm-hmm

    8. AGAdam Grant21:07

       ... of information, and you're clearly doing a lot of research." And then, you know, trying to make it a dialogue and say, "Hey, my, my job is to help you, you know, separate signal from noise, um, and really vet the rigor of these studies. So, you know, if, if you're open to it, can I walk you through what kind of study I would find credible versus not?" And I think you're not gonna change their mind in five minutes, right, by debunking-

    9. TPTrisha Pasricha21:30

       Yeah

    10. AGAdam Grant21:30

        ... the particular conspiracy or piece of misinformation they're buying into. What you wanna do is establish a relationship whereby they trust your thought process, not just your conclusions, and they wanna come to you to learn how to get e- better at critical thinking in your domain.

    11. TPTrisha Pasricha21:45

        I really like that. You have time, I think, to get them to believe that your way of thinking has some validity to it, even if you can't debunk that at that precise, precise question. I like that a lot.

    12. AGAdam Grant21:56

        Well, let me know how it goes for you.

    13. TPTrisha Pasricha21:58

        I'm gonna try it.

    14. AGAdam Grant21:58

        All right.

    15. TPTrisha Pasricha21:59

        [laughs]

    16. AGAdam Grant21:59

        So in our, in our last few minutes here, I wanna ask you a few more lightning questions if you're up for it 'cause they're just-

    17. TPTrisha Pasricha22:04

        Yeah

11. 22:05 – 24:13

    Taboo but practical GI truths: fart odor control and fecal incontinence prevalence

    1. AGAdam Grant22:05

       ... so fun. One is, uh, I did not know until I read your book that it's possible to fight the smell of a fart. How?

    2. TPTrisha Pasricha22:13

       Yeah. A lot of people think it's an inevitability, but actually 99% of the gas that you release is odorless. It's only that 1% that contains sulfur that's the problem. Okay, not surprising. It's the simplest solution. Bismuth subsalicylate, found in products like Pepto-Bismol, can neutralize the odors. So I don't think that we need to be, like, taking this every day the rest of our lives 'cause I actually, like, don't think we need to live with that level of embarrassment. Once you know that people on average fart 10 to 20 times per day, you might realize you're not so different from everyone else.

    3. AGAdam Grant22:48

       [laughs]

    4. TPTrisha Pasricha22:48

       But I think if you have, like, a high-risk social event, like you're visiting your in-laws for Thanksgiving or you're, like, you know, in this, like, intimate work co- and you just, you, you need that for your confidence, like, go ahead and take it, like, a day or two beforehand, and you actually will be able to neutralize it. You have to, you have to work a little bit harder about the sounds, but you can definitely get rid of the odor.

    5. AGAdam Grant23:07

       Speaking of reassuring information, what percent of adults poop their pants?

    6. TPTrisha Pasricha23:12

       Gosh, 7%. So it's more than, again... Like, that's a big number if you think about the activity we're talking about. It's a big number. We don't talk about it. What it does tell me is that you're not alone if that's you. Um, 7% poop their pants, like, regularly. The kind of, again, encouraging part of that is that for a lot of the reasons why this happens, we have really good treatments. This, f- we call it fecal incontinence, is one of the things that of everything we've talked about today that- People listening are like, "Well, this is so embarrassing." It is so embarrassing that we know because we've done these studies in GI, if the doctor doesn't ask the patient very specifically, "Do you have this? Do you poop your pants?" Patients do not bring it up on their own. Like, that is very rare. Even though they'll come to that visit, that is the most distressing thing. It is this thing that makes them say, "I can't leave my house." So if anyone hears this, it's common. Talk to your doctor if your doctor has forgotten to ask you about it, because the good news is that we can actually treat it. It's not inevitable.

12. 24:13 – 25:33

    Detox and colon cleanses: your liver already does the job

    1. AGAdam Grant24:13

       Okay, one other myth to bust here. A lot of people have, I think, become fans of doing a colon cleanse or a detox ritual because they think there's poop or toxins lurking in their gut. Not true?

    2. TPTrisha Pasricha24:26

       Not true. There is this cult of detoxification around us. Like, detox culture is everywhere, and I actually, I kinda get where it comes from, like, both in our current moment, which is, like, you know, we think there are chemicals in the environment, in our foods, in pesticides, in toxins. And, and, and I think it can feel really overwhelming, like we're putting poison in our bodies, and that's not the case. Like, the awesome news is that everything that comes through your gut, it gets filtered first by your liver before it hits the rest of your circulation. Your liver is the cleanse that you need. Like, there is nothing, there is no celery juice you could sip that is gonna do a better job than your liver. And so, like, just I wouldn't worry so much about detoxing with, like, a quick fix. What I would worry about is, like, what is my long-term dietary habits? What are the patterns that will, over time, stress my liver? And that is things like alcohol and ultra-processed foods, and things that your doctor has been, like, beating you on the head over for, like, the last 50 years of your life that you kind of already knew.

    3. AGAdam Grant25:28

       That's actually really encouraging [laughs] on a, on a, on a-

    4. TPTrisha Pasricha25:31

       Yeah.

    5. AGAdam Grant25:31

       I, I have had a lot of people-

    6. TPTrisha Pasricha25:31

       Yeah, cancel, cancel that colon cleanse.

13. 25:33 – 29:17

    From plumbing to “second brain”: why poop fascinates and why noticing symptoms matters

    1. AGAdam Grant25:33

       Yeah, I wasn't planning to do one, but I'm, I'm glad to know that that was not a bad call. I have to tell you, [laughs] I, I, I was not sure what I was gonna make of this book that you wrote.

    2. TPTrisha Pasricha25:45

       [laughs]

    3. AGAdam Grant25:46

       'Cause I, I think people are disgusted and grossed out by poop, period.

    4. TPTrisha Pasricha25:51

       Yeah, totally.

    5. AGAdam Grant25:52

       But then I was reminded of this research that Paul Rozin did on disgust. So b- uh, Paul's basic argument was that, you know, disgust evolved to keep us safe.

    6. TPTrisha Pasricha26:01

       Yes, yeah.

    7. AGAdam Grant26:01

       And we're disgusted by things that are toxic. And yet some things that, that disgust us also intrigue us. He said, and I, I'm gonna paraphrase here, but I, I, uh, it stopped me in my tracks when he said, "Okay, so most people are grossed out by, by f- poop in all forms."

    8. TPTrisha Pasricha26:18

       Yeah.

    9. AGAdam Grant26:18

       "And yet most people are also curious about poop, to the point that-"

    10. TPTrisha Pasricha26:22

        100%

    11. AGAdam Grant26:22

        "... after they take a dump they will look in the toilet and observe the shape and the color." And so-

    12. TPTrisha Pasricha26:28

        [laughs]

    13. AGAdam Grant26:28

        ... this is kind of my long preamble to say, I think I've come around to the idea that this thing you study that people are disgusted by, like, they're also sort of intrigued by as adults, not just kids. Like, why? Why?

    14. TPTrisha Pasricha26:42

        [laughs]

    15. AGAdam Grant26:42

        What's going on here?

    16. TPTrisha Pasricha26:43

        Yeah, and you're asking someone who does this for a living, so we're in the, like, right space. But now I'm intrigued, too. I mean, were you surprised because you are one of those people who takes a look, or because you're one of those people who absolutely says like, "No, I don't look. I just flush-"

    17. AGAdam Grant26:57

        I-

    18. TPTrisha Pasricha26:57

        "... and I move on with my day"?

    19. AGAdam Grant26:58

        I'd never even thought about it, and I didn't wanna think about it.

    20. TPTrisha Pasricha27:01

        [laughs]

    21. AGAdam Grant27:01

        And it was so, [laughs] it was so weird to me that, like, that somebody thought about it.

    22. TPTrisha Pasricha27:06

        Well, there's, like, a serious answer and then there's, like, maybe the more real answer for, like, why people study this. And, like, I would say the serious answer is that your gut and your gut health, and it's a broad term, is so important to your overall health. And when we take a bigger step back and we look at what's happening in the world today, where a big conversation is about these early onset cases of colorectal cancer that we're missing, and we're missing them because people aren't bringing to their doctor's attention the symptoms about their gut because they're so embarrassed by it. People aren't even looking. They're not even looking before they flush. And, like, honestly, when I hear that, and I hear that from a lot of my patients. They're like, "Oh, I don't look." Because my first question is, "Well, what does your poop look like?" You know, then I, I find that bizarre because I think, like, how can you not look? And so then that takes me to the, like, lighter side of this whole equation, which is, you know, in my world of neuro GI, it's kind of a relatively new subspecialty, but it's also the coolest subspecialty. Like, the science is so exciting and emerging that I just think the way we've thought about our poop and about our bowels in a lot of ways has been proven so wrong over the last decades. And that's because I think for centuries, if not longer, we thought of our digestive tract as just this plumbing system, right? And it's like you eat, you poop it out, and that's, like, kind of the end of the story. And then the microbiome entered the chat, like, you know, 20, 30 years ago, and the whole world changed. And then we realized, and we came t- kind of had hints that this was true earlier, that your gut is not just a set of pipes. It's a brain. It has this thing called an enteric nervous system, and if you shift that way of thinking, as I have, instead of thinking about your gut as this, like, holding cell for your poop, and you think about it as a brain in and of itself, then one, you're not disgusted by it. You are fascinated by it. B- but then you also come to learn about all the different ways that not just your brain influences your gut, which is, you know, what we were hinting at with the gut feeling, but also how your gut is influencing your brain. But the science of it is so exciting. [laughs]

    23. AGAdam Grant29:13

        Okay. So I have to ask you a, a bunch of things now.

    24. TPTrisha Pasricha29:16

        [laughs]

    25. AGAdam Grant29:16

        [laughs]

14. 29:17 – 36:28

    Poophoria: why a good bowel movement brings relief (and how to make it easier)

    1. AGAdam Grant29:17

       The, the first one is I remember, this was also in grad school, we were in a seminar talking about the difference between happiness and joy.

    2. TPTrisha Pasricha29:24

       Mm.

    3. AGAdam Grant29:24

       Happiness being, you know, more of a, you know, typically cognitive evaluation of, like, how satisfied are you with your life, and joy being the momentary, you know, exuberance that you get when you have a peak experience. You know where this is going. Some psychologists have done-

    4. TPTrisha Pasricha29:40

       I, I'm so excited.

    5. AGAdam Grant29:41

       Um, [laughs] it was an experience sampling study where you get at joy by instead of just asking people, "How happy are you?" And then trying to figure out what did you do that day. Basically, what they did was they, they texted or pinged you at different times throughout the day, and they said, "Right now, how much joy do you feel, and what are you doing?" And- The, the conclusion from my colleague who was presenting this study to us was we're really just animals.

    6. TPTrisha Pasricha30:05

       [laughs]

    7. AGAdam Grant30:05

       Because the, the, the two highest moments of joy consistently in the data were having sex and sitting on the toilet.

    8. TPTrisha Pasricha30:14

       Yep. That tracks.

    9. AGAdam Grant30:15

       I remember our professor saying, "Joy equals sex plus shit." [laughs]

    10. TPTrisha Pasricha30:20

        That sounds like an amazing class. [laughs]

    11. AGAdam Grant30:22

        I mean, it was, it was a weird class in a lot of ways. But I think that that foreshadowed something that you write about in your book, which is the idea that people feel some degree of extreme joy when they are having a bowel movement. Explain this to me.

    12. TPTrisha Pasricha30:38

        Yeah. That is a concept that I call poophoria. And for example, right now I, I see a lot of patients with Parkinson's, 'cause that's what I study in my laboratory, and h- the GI symptoms of Parkinson's, and we can talk about that. But how, how GI, how Parkinson's might begin in the gut. And as everyone knows, when you have something like Parkinson's disease, you have a lot of other very severe symptoms, things like tremors, difficulty walking, difficulty speaking. And yet when you talk to these patients, people will tell me if they could trade away one thing, whether it's the tremors or the constipation or difficulty sleeping, it would be the constipation. Like, they would rather live with tremors than they would live with the severity of their GI symptoms. And I find that to be true almost across the spectrum, that no matter how successful you are in life, no matter what else is going on, what other disease you have, if you cannot eat the food that you love and you cannot poop it out properly, people just don't feel joy. They don't feel like they have achieved, like, a high quality of life. And what I talk about when I'm talking about poophoria is, like, two stages, right? And one is, like, I think long-term satisfaction with your bowel habits. And for me, that's actually where having a bowel movement is the absolute least of your daily concerns. And in 40% of Americans, this is something that disrupts their daily lives. It's like a huge number for something that we actually may or may not have a diagnosis attached to, we may not be talking about enough, but that's a lot of people who are not happy, this is a long-term issue, because they're not pooping well. But then there's also this, like, interesting phenomena, which again, we don't talk about that much probably out loud, uh, on a podcast or with friends, um, which is that, like, people feel such immense joy when they have a good bowel movement. And I actually do think that there's, like, two reasons why this happens. [laughs] One, it can be hard work for a lot of people. Like, it's not effortless. It's not easy. And so, like, sometimes people having, like, a nice, good bowel movement really feels like a relief because they know now, the rest of my day is not, I'm not gonna be thinking about this and worried about where the bathroom is and feeling that heaviness. So it's like a big sense of relief. And also, there is this surge through your vagus nerve in order to have a bowel movement. That's very relaxing. That's, like, you have to have that in order to have a good bowel movement. So there's both this physiological pieces and this sense of, like, achievement and relief that comes with having one.

    13. AGAdam Grant32:56

        Is that related to dopamine? Because you've also shattered one of my assumptions about where dopamine lives.

    14. TPTrisha Pasricha33:03

        [laughs] Yeah. So most of your body's dopamine comes from the gut. And, and I mentioned that my laboratory studies Parkinson's disease, but that's really, what we really study is dopamine signaling in the gut. And this is true, you'll hear this of a lot of other neurotransmitters that we think of as pr- predominantly being brain-centric neurotransmitters like serotonin. That too is mostly produced by the gut. With dopamine though, the dopamine produced by your gut actually doesn't cross the blood-brain barrier. So it's not necessarily as though the dopamine produced by your gut is the thing that's immediately giving you that hit of, like, satisfaction. I do think that comes ... I think you get that, I think. But I think that's predominantly coming from the experience in your mind playing out about that, like, genuine sense of, of relief.

    15. AGAdam Grant33:44

        Got it. Okay, so what's your, what's your advice on how to get to poophoria?

    16. TPTrisha Pasricha33:49

        Yeah. Well, you know, sometimes I start with just the basics of what modern life has taken from us. And sometimes that conversation starts with me just saying, "How are you sitting when you have a bowel movement," right? And everyone's like, "That's a weird question. I just, I just sit on the toilet, like, as, as, as one would." Um, and actually, that's not the best or most natural way to have a bowel movement. And when you sit in this, like, 90-degree angle, like you're sitting on a chair, there's a kink in your colon. That tube is not all the way open. When you squat, as many people used to do in the past, far fewer are doing that today for all the reasons I understand, that actually, the tube straightens up and you're able to pass stool a lot more easily. And of course, the next point is, like, nobody wants to squat. I get that. But what you can do to achieve that, to open up that angle again, is just to raise your knees above the level of the waist. You can use a stool, you could use a stack of books, you could use a pair of stilettos. As long as you raise your knees above your waist, even healthy people say, "Oh my gosh, I had no idea. This is way easier than it was." Another thing I talk about often is, like, bringing our smartphones into the bathroom. That is, like, a big problem with our modern life, uh, speaking of dopamine. But when you bring your smartphone-

    17. AGAdam Grant35:01

        [laughs]

    18. TPTrisha Pasricha35:01

        ... into your bathroom, you're getting distracted by design. Uh, and you know, we did this study in my laboratory where we found that people who bring their smartphone in the bathroom, which is everybody, okay, there's no shame in that, um, but those people, about half of them said they spent longer in the bathroom than they intended because they were distracted by their phone. That's not so surprising. Like, there's no way we can expect you to focus on the job at hand in the bathroom if you have your smartphone and you're, like, in the middle of doom scrolling. And it's not so much like, oh, this is just gonna waste your time. We're, we're worried that this is what's driving hemorrhoids in a lot of people, because you're, the longer you sit on this open commode without any pelvic floor support, the more those hemorrhoidal veins, they fill, over time that connective tissue weakens. So this is a habit that it's probably simpler to say we should break than it actually is, 'cause we're all so addicted to our phones. But it's like one of those things, like, just like we don't bring our smartphone to the, to the dinner table, to the, to the bedroom, we probably shouldn't be bringing it to the bathroom either.

    19. AGAdam Grant36:03

        Ooh, good advice.

    20. TPTrisha Pasricha36:04

        [laughs]

    21. AGAdam Grant36:04

        Well, Trisha, this, this has been every bit as fun and enlightening as I hoped, and also less gross.

    22. TPTrisha Pasricha36:10

        Yeah. I hope, I hope you feel that way, and I hope you take a look next time.

    23. AGAdam Grant36:13

        [laughs] I can't say I plan to.

    24. TPTrisha Pasricha36:17

        [laughs]

    25. AGAdam Grant36:17

        But thank you for, thank you for joining us, and at least inviting me to rethink that. [upbeat music]

Episode duration: 36:42