Episode 396: The Truth About Poop with Dr. Trisha Pasricha
Butt care is self-care! Doree and Elise have the gastroenterologist and the “Ask A Doctor” columnist for The Washington Post, Dr. Trisha Pasricha, on to discuss what we’re getting wrong about pooping! They talk about what it really means to nourish your microbiome, the secret weapon that is fiber, the digestive power of going for a fart walk, her new book (aptly titled You've Been Pooping All Wrong), and so much more.
Photo credit: Barry Braunstein Photography
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Transcript
The following transcript is AI generated.
Doree Shafrir (00:10):
Hello and welcome to Forever 35, a podcast about the things we do to take care of ourselves. I'm Doree Shafrir.
Elise Hu (00:16):
And I'm Elise Hu and we are two friends who like to talk a lot about serums.
Doree Shafrir (00:21):
Welcome to the show, one in all. We have a very poopy episode for you today. It's the first time-
Elise Hu (00:33):
I didn't think that was a great tease.
Doree Shafrir (00:36):
Well, look, I just want people to be aware that we are talking to a gastroenterologist for the first time on the show, Dr. Tricia Pasricha. And she really just gets in there.
Elise Hu (00:48):
You gets in there is a nice pun. Thank you. She does colonoscopies, endoscopies. She is also crucially an author of a new book called Your Pooping All Wrong. You've probably seen her on your socials on TikTok or Instagram because I've seen her a lot and because I guess my algorithm really likes her and I really like her. She is the ask a doctor columnist for the Washington Post. And so she can answer all sorts of questions about our bodies, but she gets a lot of questions about our gut. So we're getting into those sorts of subjects or questions in this episode. But first, here we are. We got to catch up.
Doree Shafrir (01:34):
Yeah.
Elise Hu (01:35):
Doree, any headlines you want to update me with?
Doree Shafrir (01:38):
Well, Elise, we are about to embark on another season of tennis.
Elise Hu (01:43):
Oh, it's a transitional time. It's
Doree Shafrir (01:46):
A transitional time.
Elise Hu (01:47):
Okay. Okay.
Doree Shafrir (01:48):
Here in USTA League land. We have wrapped up the winter season.
Elise Hu (01:55):
Got it.
Doree Shafrir (01:56):
And we are entering the spring season. The spring season kicks off this week.
Elise Hu (02:01):
Oh, are you still captaining or are you going to take a break?
Doree Shafrir (02:04):
No, I sure am.
Elise Hu (02:05):
Oh, okay.
Doree Shafrir (02:06):
I think I'm going to take a break this summer, actually.
Elise Hu (02:09):
Okay.
Doree Shafrir (02:10):
Because in LA, the summer leagues are 40 and over mixed
Elise Hu (02:17):
Doubles.
Doree Shafrir (02:18):
Okay.
Elise Hu (02:18):
Yeah.
Doree Shafrir (02:18):
I don't love mixed doubles. The men bring a certain energy to the court that I'm just not-
Elise Hu (02:24):
Well, and to life.
Doree Shafrir (02:26):
And to life. Yeah. It's like some of us joke. We're like, why is there a man on the court? This is our little
Elise Hu (02:32):
Sacred- It's harshing my vibe.
Doree Shafrir (02:34):
It is
Elise Hu (02:34):
Harshing
Doree Shafrir (02:35):
My vibe. I mean, look, I don't want to paint them with two bra to brush, but they tend to bring a certain energy that I just am like ... I'm like, I do this for fun. I don't need these vibes.
Elise Hu (02:47):
Well, plus you don't get to choose who you're playing against in the league or who is necessarily on your team in the league.
Doree Shafrir (02:53):
Yeah.
Elise Hu (02:53):
So I would love to play tennis with a bunch of my guy friends, but that's not what you necessarily get.
Doree Shafrir (03:00):
Right. Exactly. You're
Elise Hu (03:01):
Getting a lot of randos.
Doree Shafrir (03:02):
You're getting a lot of randos. Yeah. And you don't know if the opposing team, the guy is going to decide he just wants to bean it at the woman, which happens a lot. It's just not cool. Anyway, so that's one of the summer leagues. And then the other summer league is called Tri Level, where you basically have a small group of people at three different USTA ratings. And I've done TriLevel the past two summers and I don't know. It's kind of a pain in the ass to put the teams together.
Elise Hu (03:33):
Okay.
Doree Shafrir (03:33):
It's just a lot. And I was like, "You know what? I don't think I want to do that this summer."
Elise Hu (03:37):
Well, it is just volunteer work too. You don't have to do it, right?
Doree Shafrir (03:40):
Volunteer work.
Elise Hu (03:41):
Correct.
Doree Shafrir (03:42):
I don't have to do it. I'm not obligated to do it. So I'm going to do the spring season. I'm captaining my teams and then summer I'm going to just kind of chill. How about you? What's new with you?
Elise Hu (03:56):
I am on spring break and I have only two kids. I always feel like when I'm down to two kids, I am killing it. I'm just like, dang, I am awesome with only two kids. No offense to whichever third kid that I'm talking about. I just mean it's just like, man, we can do ... We went to a museum yesterday and the family pass was for four exactly. And so that was the number that I had. I didn't have to do any extras. We can fit into cars easily with the dog. There's just some advantages of having this particular even number. And the reason why I'm down a kid is a really cool reason, just Ava is in Peru. She was in Machu Picchu yesterday, saw a double rainbow. Today is on some sort of riverboat or something going through the Amazon rainforest. She was in the Sacred Valley.
(04:59):
They visited an elementary school there. They had the universality of kids being kids with each other. They played soccer with these Peruvian elementary school kids. They were in Lima. They were in Cusco. She was at 12,000 elevation. There were some kids who were really getting altitude sickness. She's just been all over the place. Planes, trains and automobiles. Every morning they seem to have a 6:00 AM departure for the next plane or the next train ride. And so I imagine she is just wiped out, but it seems like, oh my God, they were holding baby alpacas.
Doree Shafrir (05:39):
Is there a reason or a theme for the trip? Why Peru? What are they doing?
Elise Hu (05:49):
So her favorite sixth grade teacher leads a tour group through one of these student travel companies. So it's not officially a school trip. It's sanctioned by the school. And a teacher at the school leads the trip, but anyone can go on it really and sign up to be part of this group. Oh,
Doree Shafrir (06:09):
Interesting.
Elise Hu (06:10):
And so it's all kids from the middle school, but also a lot of parents. So they're traveling as a group of 40. Whoa. Yeah. As a group of 40, because I think it's 20 of the members of this group are full families.
Doree Shafrir (06:26):
Wow.
Elise Hu (06:26):
And then nine of the kids are traveling solo, which is what Ava's doing. Ava's
Doree Shafrir (06:31):
Doing.
Elise Hu (06:32):
Yep. And then there's other teachers from the school and other adults who are chaperoning and who wanted to go, who might just be like one parent of one kid instead of like a full family. I think she's a world history teacher, so she likes to go to places with ancient civilizations. How cool. And halfway through though, Ava, I think she was just kind of crashing out because she's wiped out. And she was texting me going, "I just want to be by a pool eating in and out like you guys are. " Because that's what we're doing. We're doing this very retiree life, Scottsdale, Arizona spring break. And we're going go- karting and doing to the slide park and going to the museums and just spending breakfast, lunch, and dinner beside the pool. And I think that's what Ava's really coveting, even though she's a freaking Machu Picchu, seeing a double rainbow and just the magic and the energy of that I really am envious of.
(07:30):
But I was actually talking to my therapist about this this morning and he's like, "There's something about Peru that I hear is very magical." He's never been either. And he was just like, "I bet it's one of those things." And I was like, "I hope Ava's having a good time because she's homesick and she'll text every once in a while and be like, I don't know if I'm a Peru girly. I think I'm just like a tan by the beach girly, which is very her."
Doree Shafrir (07:54):
I mean, look, I get it.
Elise Hu (07:56):
But there are many kinds of girlies you can be. We contain many girlies and- You
Doree Shafrir (08:02):
Know what, Elise, that is so true. We all contain many girlies.
Elise Hu (08:06):
That's right. That's right. And I was saying, I worry that Ava doesn't love history and the journey as much as I did as I was a kid because I remember keeping extensive travel logs when we traveled the American West and did all the national parks. And I'm just like, "I don't know that Ava's really getting into the indigenous populations there and blah, blah, blah." And he was like, "There are experiences that you have in your life that seep into your pores, they seep into your being." And it's just like, it doesn't really matter if she remembers the facts of where she was or the play by play of what was on the agenda each day. It's actually just how the experience itself sort of is written on you later on. And it'll reverberate in different ways that are really valuable and that make it a really good investment.
(09:00):
So that was a nice thing to remember. And I think that's true about a lot of the places that I've been or seen. I don't really remember the details that well. I just remember the vibes. And I think that that's enough to have changed me in one way, even if it's indescribable.
Doree Shafrir (09:18):
Yeah. I mean, I think this is such an amazing experience that she's getting to have. And I get it. When you're in the middle of it and she's not getting a lot of sleep and she's away from her family, her family's just chilling. I get it, but I think she will look back on it and be like, "Wow, that was really cool."
Elise Hu (09:44):
I'm sure it's going to be really cool to look back on.
Doree Shafrir (09:47):
Yeah, for sure.
Elise Hu (09:48):
And make for some great stories.
Doree Shafrir (09:50):
For sure. Elise, do you want to introduce our guest?
Elise Hu (09:55):
Yes. I'm excited too. Dr. Tricia Pasricha is an instructor of medicine at Harvard Medical School and the ask a doctor columnist for the Washington Post where she translates complex medical topics into must read insights with a touch of humor for millions each week. A graduate of Harvard College, Dr. Pasricha, earned her medical degree from Vanderbilt University School of Medicine and her master of public health from the Harvard T.H. Chan School of Public Health. Her training includes an internal medicine residency at the Johns Hopkins Hospital and gastroenterology and motility fellowships at Mass Gen. Currently, Dr. Pasricha serves as director of the Institute for Gut Brain Research at Beth Israel Deaconess Medical Center, leading an NIH funded research laboratory at the forefront of gut-brain science. She does know a lot about gut health. Her work has been published in all the big ones, the New England Journal of Medicine, JAMA Network Open and Nature Reviews.
(10:52):
Crucially, she helped us with some like just really basic questions we had about bloat and constipation. And Doree says this is probably the most educational interview that we've had in a long, long time.
Doree Shafrir (11:04):
All right. Before we get to Dr. Pasricha, just a reminder that you can call or text us at 781-591-0390. You can email us at forever35podcast@gmail.com. Our website is forever35podcast.com. We have links there to everything we mention on the show. We are also on Instagram at Forever35podcast and join our Patreon at patreon.com/forever35 because not only do you get the semi-monthly newsletter, not only do you get the casual chat, not only do you get our community chat on Patreon, our monthly pop culture recommendation episodes at the $10 level, the ad free episodes and a shout out on the podcast every month, but we are also doing live casual chats quarterly roughly. So the next one is on Wednesday at 12:30 Pacific, 3:30 Eastern. We'll be live. You can be asking us questions, chatting with us, and you just have to join the Patreon before that to get access.
(12:09):
So I was thinking about it. It's kind of like you're just paying for a live show,
Elise Hu (12:15):
Five
Doree Shafrir (12:15):
Bucks.
Elise Hu (12:15):
That's less than a coffee these days at Starbucks or anywhere.
Doree Shafrir (12:19):
By the way, even a drip coffee at Starbucks is like $4. And then if you want any sort of latte, it's at least $6.50. I mean, it's crazy. Yeah. Thank you for bringing that up. That is one of my pet peeves these days. All right. We're going to take a short break and we will be talking to Dr. Pasricha when we get back. Stay tuned.
Elise Hu (12:42):
We'll be right back.
Doree Shafrir (12:50):
Dr. Tricia Pasricha, welcome to Forever35. We're so excited to have you on the show.
Dr. Trisha Pasricha (12:56):
Thank you so much for having me.
Doree Shafrir (12:58):
We have a lot to discuss. One of the big topics of conversation I was saying about my previous co-host, Kate, was butt care. So this is a very relevant topic for a lot of our listeners, I think. But before we get to poop and butts, we always ask our guests about a self-care practice that they have. So is there something that you would consider self-care?
Dr. Trisha Pasricha (13:25):
Yeah. I mean, for me, my self-care is I think about what I am feeding my microbiome every day. So I practice self-care by saying, "Did I feed something specifically for the microbes that are living inside me? " And then when I do, it helps my overall wellbeing and in my health. So I think about that.
Elise Hu (13:46):
I have an immediate follow-up question because what does it mean to properly feed our microbiome?
Dr. Trisha Pasricha (13:54):
A fantastic follow-up question.
(13:58):
It means feeding it something that's rich in prebiotics or probiotics. And I think it's very easy to go about your day eating a lot of ultra processed foods and refined carbs and things that will not make their way to those microbes. They'll just get absorbed very quickly. So I think about, did I eat something that's high in fiber? Did I eat something like Greek yogurt maybe? That's sometimes what I do, that's my probiotic. But something that's specifically nourishing the bacteria that by design is not going to be absorbed, that you are not capable of digesting or absorbing. It will continue along your digestive tract to your colon and it'll feed them.
Elise Hu (14:36):
Okay. I really have to think about this in terms of the kids too. I feel like my kids eat all beige foods.
Dr. Trisha Pasricha (14:46):
Yeah. I have a two-year-old and four-year-old, so I get it. We love a good chicken nugget, but I also, I do make their breakfast, and this is what they like. They eat a ton of nuts. I think all morning they're snacking on ... Luckily we don't have nut allergies in the house, and they also love kiwis. Kiwis is like my secret weapon with kids. They like kiwis, helps them poop, it would help us all poop, but I give them two kiwis before bedtime, and they do great.
Elise Hu (15:14):
That's a great hack.
Doree Shafrir (15:17):
And I think this will help as we kind of transition into talking about your book and your work, but could we just sort of back way up and talk about what are we talking about when we talk about the microbiome, gut health, like all of these sort of buzzwords that I feel like we're hearing right now, and why do they matter?
Dr. Trisha Pasricha (15:38):
The gut refers to this long tube that connects things from your mouth, your esophagus, your stomach, small bowel, large bowel, and then your exit hatch. That whole area is your gut. And the two things that I think we don't appreciate about that, I think everybody understands that kind of basic plumbing. We don't appreciate that your gut has its own brain and it has this network of neurons that is as complicated and as numerous as the number of neurons in your spinal cord. So I always think about my gut as a brain and gut health being closely tied to that connection between the brain and our stomachs and the brain in our heads. And then the microbiome, like you mentioned. The microbiome are these trillions of microbes that are living with us mostly in our colon. There's some also in our small bowel and other places.
(16:23):
And they're not just these passive creatures that we have to feed. We do have to feed them. But what's so cool about the microbes is that depending on what we feed and how we treat them, they produce these compounds entirely on their own that we're not producing independently. Those compounds can then get absorbed into our bloodstream and have these anti-inflammatory effects everywhere. So when I talk about gut health, I think about it as well, the way you're treating your gut and the way you're making sure that you are respecting, healing your gut actually has an impact on your whole body. It's really your whole body health when we talk about gut health. So there are a lot of different angles you can go in this. I find there are a lot of people who like to go down the route of like, "Here's a gut health hack and here's the quick fix." And there's often not a quick fix in GI in my field.
(17:13):
And most of what I tell people and talk about are about building habits and lifelong changes. Those are harder to implement, but they are the things that stick and have really important outcomes for our health.
Elise Hu (17:24):
So your new book is called You've Been Pooping All Wrong. I didn't know we were pooping all wrong. So what are we getting wrong exactly?
Dr. Trisha Pasricha (17:35):
Yeah. What are we getting right is a better question to start with. But one of the statistics that prompted me to write this book was, and I saw it in my clinic in everyday real life, which is that 40% of Americans will say that their bowel habits disrupt their daily lives.
Elise Hu (17:51):
Oh my gosh. And a
Dr. Trisha Pasricha (17:52):
Huge, huge number of people.
Elise Hu (17:55):
And
Dr. Trisha Pasricha (17:55):
It's almost like disproportionate to the number of people you think when you go about your day, you go to work, you see people in the grocery store, like 40% of us all living lurking around us are really struggling every day. We just don't talk about it as much as we should. And I
(18:10):
Came to realize that a lot of what we know about pooping, most of what most people know about pooping is what their parents taught them when they were potty training. That was the last and most important conversation you had about how this is supposed to work. The science has changed within the last several decades, centuries, but we're still kind of learning our great-grandmother's method. It's not right and it's not helping us. And I think that's how we ended up in this situation where we are today, where we are not talking about our problems, we're not teaching each other and our kids what the right sort of scientific way to do this is and about our bodies. And that's why almost half of us struggle with this every single day.
Elise Hu (18:45):
So for the two out of five Americans who answered the survey this way, how are their bowel habits disrupted or disrupting the day?
Dr. Trisha Pasricha (18:55):
Yeah. I mean, the ways that I hear this when people come to my clinic will be like, for example, people cannot leave the house because they're embarrassed to say, "Yeah, I'll go out to brunch with my friends because they're like, well, what is the bathroom situation going to look like? " Or they'll be like, "I could
Elise Hu (19:08):
Go
Dr. Trisha Pasricha (19:08):
For this walk with my dog, but what if we take a detour and I'm not going to make it back in time. Let me just stay at home. Let me not go. " Or it could be in a situation where they spend so much time in the bathroom every morning that their partner gets annoyed at them for hogging the bathroom and they get late to wherever they need to go. And or every time they eat, they feel pain and cramping and discomfort and it keeps them from being able to focus. So there's a number of different ways and everyone is a little bit different, but ultimately for a lot of people, it can stem back to the same misunderstanding about how the bowels work and then the lack of knowledge about how to apply the treatments and the fixes that can get you back on track, not necessarily with medication.
(19:53):
And there are medications that treat a lot of different health disorders, but oftentimes I find that sometimes teaching people some of the absolute basics, even just about what is normal when it comes to bowel movement.This is the most basic question, but is my poop normal is what a question I get all the time. People don't know what normal looks like. And once you learn some of these elementary, what I consider very elementary things, then you actually can't figure out ways to kind of get yourself on track so that your life isn't hijacked by your bathroom.
Elise Hu (20:23):
So how would you define normal pooping or normal poop?
Dr. Trisha Pasricha (20:26):
This is the question. Question. That is the question. Well, there are a lot of different metrics that people throw out there. People think that what I'm about to say is going to be we have to poop once a day. That's what makes you normal. And we have held this number one in this godlike position for so long. And in my mind, that's actually not the definition of normal. I have met many people who poop once a day and they're not normal and they're struggling and they're straining for 15 minutes in the bathroom to get that one poop a day. That's constipated in my opinion. To me, what would make somebody have what I'd consider normal bowel movements would be one, it should be effortless and comfortable. Effortless means you're not sitting there straining for more than five minutes. It doesn't hurt. You don't have severe cramps.
(21:14):
And then two, it should happen in a way that doesn't disrupt your social life. This shouldn't be the thing that makes you get up and leave your group of friends when you're all sitting out at lunch. It shouldn't be the thing that annoys your partner all the time and you can't get anywhere where you need to be. So it shouldn't disrupt your social life. You should just live a life that's normal to me would be one in which pooping, how many times you're going, what it looks like, what it feels like is actually the least important thing of your whole day.
Doree Shafrir (21:43):
And so what do you do if your poop is not normal?
Dr. Trisha Pasricha (21:48):
Well, the first step is to even understand what's normal for you. I mean, you'd be surprised at how many people I see who, like for example, if I ask them, "Well, what did your poop look like this past week? Give me a sense." And they'll be like, "Oh, I didn't really look
(22:06):
Every day." And I'll be like, "First of all, how do you not look? I don't understand." But then two, you have to know what your normal habit looks like and you have to know what these small changes in your own pattern look like for you to identify when something is abnormal. If you don't know what's normal for you, and that does mean taking a look and understanding how changes in your diet and stress and travel, all of these things are going to change what your poop looks like and what it does. If you understand that and then you see a change, you have to talk to your doctor. And there are some scenarios where I would say it might not be such a big deal if you see a change in your poop. Maybe we have a good explanation, but to be honest, in today's day and age, it's like 2026, colorectal cancer cases are rising in younger people.
(22:51):
And one of the big signs is as vague as a change in your bowel habits. That's like a really nebulous thing to say kind of deliberately because sometimes the only sign is new diarrhea, like just slightly looser stools than you're used to. Or maybe suddenly the stool goes into like this pencil thin form and it wasn't like that before. So subtle changes in your pattern can actually be incredibly important. The most likely scenario is that it's no big deal. We'll figure out what that etiology is, but
(23:23):
We also want to make sure we're not missing anything scarier.
Elise Hu (23:26):
Right, right.
Doree Shafrir (23:27):
So what I'm hearing from you is that we all need to be a little bit more in tune with our bodies and what comes out of our bodies, because if we don't have this sort of baseline, then how do we know if something is not normal for us?
Dr. Trisha Pasricha (23:45):
Yeah. I mean, there's this really disturbing statistic. This was from a UK study, but about one in three people are so embarrassed by their bowel habits that they will avoid talking to their doctor. And that's the last thing we want. We want you to talk to your doctor early and often. I don't think it has to be ... I think, especially with younger people, oftentimes you think that it has to reach a crisis for you to talk and get help. And it doesn't have to be a crisis. It just has to be a change. Just get that quick reassurance. Oftentimes it will be no big deal, but if you delay ... And again, I'm using the extreme case of cancer, but with colorectal cancer, that's one of the reasons that we catch it at a later stage in younger people is because there's this big delay in capturing it.
Elise Hu (24:32):
Speaking of this big rise in colon cancer or colorectal cancer, especially among younger people in their 30s, what is the explanation for that from what the research can understand right now? And then what do we do about it?
Dr. Trisha Pasricha (24:45):
Yeah. It's been rising since about the 1980s and 1990s in younger people.
Elise Hu (24:52):
And
Dr. Trisha Pasricha (24:52):
Researchers think that, one, we know that the big risk factor for cancer, which we used to think of decades ago, smoking, that's certainly gone down.
(25:01):
Our genetics haven't really changed across generations. So researchers have really concluded that it's in our environment and more and more data is pointing towards food. And in the last two or three years, more and more studies have come out about ultra processed foods playing a big role. So it's probably not just one thing. I think there are a lot of different things in our environment, but I do think the umbrella of ultra processed foods covers a lot of them. So for example, it's not just the diet that we eat in our 20s and 30s when we're diagnosed. A lot of the data is pointing towards how we have been eating in our childhood, in our adolescence that's
Elise Hu (25:35):
Contributing
Dr. Trisha Pasricha (25:35):
To these early on sick cases. And I know that's ... I mean, it's something I think about a lot with my kids, but they've done these studies with sugar sweetened beverages, which when I was a kid, I was drinking a lot of those like Capri suns and all of ... I was drinking all of this stuff as a kid. Hawaiian punches. Oh,
Elise Hu (25:52):
The
Dr. Trisha Pasricha (25:52):
Best.
(25:54):
I see. I remember how I see. Had it in my lunchbox, but those types of drinks are linked to early onset colorectal cancer and drinking those in your adolescence. Ultra processed foods are a big one. And today, the average American is getting about 60% of their foods from ultra processed foods. And the problem with that is one, what's inside of them, these emulsifiers and chemicals have been shown to be linked to inflammation, microscopic inflammation in the gut, which we think contributes. But also when you're getting most of your food from ultra processed foods, it means you're not getting fiber because most ultra processed foods are just very low in fiber. Fiber is protective against many cancers, but especially colorectal cancer. I can't go back in time and like pull the Capri sun out of my hands, but I can today say, I'm going to try to make these small changes in my diet to eat more whole foods.
(26:42):
I'm going to cut down on the sugar sweetened beverages. I'm going to be more active. These kinds of things we do have some control over and certainly we can never tell somebody that we can make your risk of cancer zero, even if you do all the quote right things, right? We know these cases of people who we think have done the right things, they still get cancer. And that's probably because of these uncontrollable risk factors that happened a long time ago or are related to genes, but we do know that we can lower that risk significantly if we take a few steps.
Elise Hu (27:12):
Okay. Let's take a break and we will be right back.
Doree Shafrir (27:21):
I'm wondering how you got interested in gastroenterology. What made you want to think about people's poop all the time?
Dr. Trisha Pasricha (27:31):
I think there was never a time in my life when I didn't want to do gastroenterology. That's a weird thing to say. I recognize it's a weird thing to say, but my father was a gastroenterologist and so I'm a second generation gastroenterologist and I just grew up in this very poop friendly, poop positive household. And for me, it went well beyond just like what you might imagine having a dad as gastroenterologist, which was like, yeah, he did check in. He was like, "Hey, did you guys poop this morning?" Me and my siblings. And he would check in and make sure that was happening in kind of like a normal way. But he was also a researcher and still is, but he was so passionate and excited about his field and about how the gut worked. And in the 1990s when I was growing up, that was really when people were starting to understand that your gut is its own brain.
(28:22):
And they were understanding how powerfully, not just the brain in our heads influences our gut, but how the gut influences the brain. And so it was an exploding field. He was so excited about it. And that was really like an infectious kind of energy to be growing up around. And so I never thought of almost doing anything else other than becoming a gastroenterologist. I know that's really bizarre.
Doree Shafrir (28:43):
I love that. I love that gastroenterology is like the family business.
Dr. Trisha Pasricha (28:48):
Yeah. We like to say that your end is our means.
Doree Shafrir (28:52):
We love that.
Elise Hu (28:53):
I
Doree Shafrir (28:53):
Love that. That's great. You also write the ask a doctor column for the Washington Post and I'm wondering what are some of the common questions that you get? I write a workplace advice column for Slate, and I will say that I see the same kind of buckets of questions all the time. So I'm wondering what that is like in the medical world.
Dr. Trisha Pasricha (29:18):
Yeah. Yeah. I love writing this column because I do love hearing from readers and like having my pulse on what the conversations are. And I get a couple of different categories of questions. One, I actually think the most unfortunate category that I get is like someone writing in with a highly specific detailed medical question. I get a lot of those. And it's like, one, it tells me that we have such a broken medical system because they're not able to get attention from their doctors and owners. So that's hard and I usually can't answer those. But then I get a lot of great questions. I mean, most of the columns stem from a question that we've read about supplements and about trends on so Social media.
(30:01):
And what I find interesting is that for the most part, I think a lot of supplements, there are a couple out there that have some good data. Most of the time there's whatever supplement du jour is out there has not necessarily been backed by data. But every now and then there is a cool trend happening on social media that I'm 100% there for and I wouldn't have heard of it. And I get excited and I get ... Forget about fiber maxing. I'm totally here for fiber maxing. And I didn't know that was a thing until people started writing and be like, "Is this safe? Is this good?" And I was like, "Wow, I see zero downsides here from this trend." Other than you could get bloated if you overdo it for sure. But it's great. So I love learning about social media trends. And then I also get this interesting category of questions that people write in about what I think some people would consider a very embarrassing question, but they're writing for a friend.
(30:55):
They're like, "I have a friend who has this very, very specific, embarrassing problem." And I'm like, "You know what? It's already an anonymous column. You don't have to worry about it. " Yeah,
(31:03):
You don't have to say it. Project it onto someone else. Yeah, just say it, because I'm not going to say your name. I will never publish names or anything, but it's very interesting to see. And it's always the friend when it's often an embarrassing GI issue. And one thing I have learned over the years is that GI questions are very popular.
Elise Hu (31:22):
So
Dr. Trisha Pasricha (31:22):
It's very convenient that I'm a gastroenterologist. And it's funny how for a topic that is so some people consider taboo or embarrassing or shameful, people are looking and desperate for that information. One, when I write about a GI topic, it does so well on our site, on social media. And I think it's because people are all curious. We're all clearly 40% of us are dealing with these problems, but it's in a way comforting to get some good information from a source that doesn't involve you going into a doctor's office and making eye contact with another soul and telling them something really embarrassing about a part of your body that you don't love discussing out loud. Now everyone
Elise Hu (32:03):
Should
Dr. Trisha Pasricha (32:03):
Talk to their own doctor, but I can see the appeal of wanting to get good information, at least to have some talking points in a way that's like, you can just be by yourself under the covers, like scrolling and learning about your own body.
Elise Hu (32:17):
You brought up earlier the connection between fiber and bloating. And I know that you debunk a lot of misconceptions about bloating in your work. So what do we misunderstand or what needs myth busting when it comes to bloating?
Dr. Trisha Pasricha (32:33):
Yeah. Bloating is one of the most vexing problems in GI. And it's one of those complaints that we, I think all of us experience. Women certainly do more than men, but it's really common for people to come to their doctors with bloating. And sometimes there is a really simple solution. Sometimes it's a little bit more nuanced. And I'll start by saying that before I tell you what I think the simple solutions are, there's one scenario in bloating that I like to make sure nobody misses, which is that if you are a woman who is postmenopausal and you get new bloating for the first time, that's a big red flag. And just so you know, that's actually a really concerning sign to me. As women, we like live with bloating all the time. And so we think it's normal, but I wouldn't brush this off if you have new bloating that you wake up with because it could be a sign of ovarian cancer, which is not to scare people, but ovarian cancer is this kind of silent disease until it's not.
(33:31):
And one of the biggest missed signs is new bloating. So I start the conversation that way, but for everybody else, bloating can be quite normal. It's normal to have a little bit of bloating after meals. And some of that is what you've eaten. Some of that is how your body is processing what you've eaten. And the two most common reasons people get bloated is the kinds of foods, the kinds of foods that are difficult to digest and constipation. And sometimes people don't realize that they're constipated until we really push and try to figure out what's going on. But the big offenders in terms of foods are cruciferous vegetables, big one like broccoli, cauliflower, Brussels sprouts, artificial sweeteners gets people. They'll have these like zero sugar kind of beverages or foods. And actually what's in there are these artificial sweeteners that are notorious for causing bloating.
(34:23):
Gum chewing is a big one. If you have a CPAP mask that's not fitting correctly, that'll give you a lot of bloating. And then sometimes if you've tried, you're like, "I don't feel like it's really anything I'm eating. It's just kind of there." I ask a lot about, "Well, what are your bowl habits like? " And it turns out that a lot of people, like I said, who might say, "Well, I go every day." If you're straining a lot, if you don't feel like you get everything out, even though yeah, you go every day, you actually could be very constipated and we need to figure that out. There is a little bit of a quick fix and I usually, I'm very hesitant to say the word quick fix, okay? In most scenarios, I don't do that, but this one is actually really good. If you feel bloated after a heavy meal, the quick fix is to go for a walk, specifically a fart walk.
(35:08):
This has been oddly studied. Yeah. It's like one is- Love a fartwalk.
(35:14):
Who doesn't love a good old-fashioned fartwalk? But they've actually done these studies where they've simulated a meal. This was like the gastroenterology researchers of your ... They simulated a meal and they saw what happened when you either did a little bit of a slow walk or a little low cycling. And it's true that that meal just passes so much more quickly and efficiently when you just do a little bit of exercise within like 10 to 15 meals of finishing it up. It also lowers your blood sugar after a meal, which is wonderful for metabolic health. So I love a fart walk. If you can't do the fart walk for whatever reason, like you're stuck at home, at very least I tell people if you're feeling bloated, you should try to not give into that instinct to lie down on your couch because intestinal gas actually moves about 33% more efficiently when you're sitting upright as opposed to going fully horizontal.
(36:03):
So as much as you can with your posture stay straight, that actually will help with bloating.
Doree Shafrir (36:07):
I never really thought about what does it actually mean for digestion quote unquote. Totally. But yeah, it makes
Dr. Trisha Pasricha (36:14):
Sense. Yeah. I mean, even if you're not farting, which is lovely if it happens, it's fine if it doesn't. Your intestines do start to get triggered to move and contrapt just with your exercise. I mean, this is also why I think people who get hospitalized undergo surgeries and they're lying around in the hospital for days, it's really hard for them to have bowel movements. I remember after I had my kids and I was kind of in the hospital for a couple of days recovering, it's really hard for new moms in those first few days. Part of it is just getting up and walking. That's kind of how your gut realizes that it's time to move.
Elise Hu (36:49):
Okay. However, one thing that really affects my regularity is travel. So when I'm doing a bunch of time zone changes, when I'm flying around a lot, what is your advice for keeping it regular, keeping our poops normal when we're on the road?
Dr. Trisha Pasricha (37:08):
Yeah, that's a big one. That affects a lot of people. About one to two out of three people struggle to have a bowel movement on vacation. So you're not alone. Wow. That's a lot of people. And I think what people don't appreciate about the colon, which is that last part of our GI tract, is that it actually has a circadian rhythm and it's very different from the other organs in our body. If you can imagine, when you go to sleep, your colon actually also goes to sleep. It enters this peaceful, quiescent state. Even though all the other organs in your body, your heart's still beating, your lungs are still moving air, your colon is done for the night. And that means that when your circadian rhythm gets thrown off, your
Elise Hu (37:50):
Colon
Dr. Trisha Pasricha (37:50):
Is also equally thrown off and doesn't know how to behave. So when I travel, I do a couple of things. One, I make sure I'm sending the right cues to my gut about the time zone that I'm going to be in. So the moment I get on the plane, if I'm going to change time zones, I start thinking as if I'm already there. And the two most important things you can do are, one, shift your light cues. So if it's nighttime where you're going, put that light blocking mask on. This is not just you'll have more energy when you arrive. This is really for your gut. And then two, eating is one of the most important triggers that tells your gut what time of day it is because we don't eat at night. Eating stimulates contractions. So if it's nighttime where you're going, but you're eating a lot of food right now, it's telling your colon to stay awake, stay awake.
(38:36):
We're still on daytime. I don't do that. I start eating according to the time zone that I'm traveling to so that my colon knows where to go. But then the other thing is very simple. I think a big reason people get constipated on vacation is they don't eat the kinds of foods they eat at home. They start to eat more rich, highly refined. I mean, that's what I do when I go on vacation is I'm here to indulge. Of course. Who isn't? But I now try to make a really big point to seek out fiber more than I would have. I will eat a side of broccoli. I will order a real adult vegetable at dinner as opposed to like some weak Caesar salad, which is not actually giving me that much fiber, like a little leaf of lettuce on my burger. It's not going to cut it.
(39:14):
You have to eat a lot more fiber. And then I think the other big problem is that oftentimes when you're traveling, you don't feel like you have this safe bathroom like the one you have at home, you're like with a partner or maybe with 20 cousins, people are running to like the hotel lobby or you're like out and about and you're looking for like a friendly coffee shop. It's horrible. That will also throw people off. We have a little bit less control over that, but I think if you eat more fiber, you're drinking a lot of water, you're adjusting your time zone, you can get back on track.
Elise Hu (39:45):
Okay, fantastic.
Doree Shafrir (39:47):
Elise, do you feel confident about heading into your next
Elise Hu (39:53):
Travel? Well, I realized this about my regularity a long time ago. And so now I'm like really aggressive about eating vegetables when I'm on the road.
Dr. Trisha Pasricha (40:03):
Good.
Elise Hu (40:04):
In fact, I might not see a vegetable at home for like four or five days, but when I'm traveling, every meal is very great.
Dr. Trisha Pasricha (40:13):
Yeah. Yeah. And I would say even if you can't find a vegetable to save your life because you're on this cruise and who knows what's going on, just pack your own fiber supplement.That's the easiest thing you could do.
Elise Hu (40:24):
Oh, that's a good tip because I'm sending my daughter off on an international trip on Saturday.
Dr. Trisha Pasricha (40:29):
Yeah. Send her with a little psyllium husk.
Elise Hu (40:32):
Okay. Wow. I'm adding it to the packing list.
Doree Shafrir (40:38):
Okay. So before we let you go, I did ask my husband because he has a lot of interest in this topic. If he had any questions for you and his question- As many husbands
Dr. Trisha Pasricha (40:50):
Do.
Doree Shafrir (40:50):
Yes. His question was actually something that you already touched on that I was hoping you could elaborate on. And it is, I suspect my CPAP made me gassier. Is this possible? And I was like-
Dr. Trisha Pasricha (41:02):
Yes. Wow. He's very perceptive and he's right. I think actually I'm so glad that he noticed that because I do think actually CPAP machines fly under the radar as a cause of bloating and gas.This is one of those things that like we will have tried lots of different things in the clinic to figure it out. And then suddenly there'll be this light bulb moment where I'll be like, "Wait a minute, do you use a CPAP machine?" And then they'll be like, "Yes, I do. " And then we'll realize, you know what, it's the mask. And sometimes it can be as simple as you're actually just not wearing a appropriately fitted mask. Maybe you need a nude, a different kind of mask. I would have it checked out by a specialist. There are people who come in, assess the fit and do that, see if that's the cause, and you never know, but that one flies under the radar and it's very common.
Elise Hu (41:48):
Okay. Wow. Fantastic. All right. Dr. Tricia Pasricha, how can people find you?
Dr. Trisha Pasricha (41:55):
They can find me on Instagram. They can read my column in the Washington Post or they can check out you've been pooping all wrong, which is in bookstores everywhere.
Doree Shafrir (42:03):
Thank you so much. This was very, I would say one of our most educational conversations ever. So thank you.
Dr. Trisha Pasricha (42:10):
I'm u. Thank you.
Doree Shafrir (42:14):
All right. Well, I do feel much more educated on my colon and my butt after talking to Dr. Pasricha. I really feel like we probably should have had Kate Spencer on as a guest.
Elise Hu (42:27):
Oh my gosh. It'd be perfect.
Doree Shafrir (42:28):
Yeah, it would have been perfect. But anyway, I hope she listens to this episode. All right. The intention zone. Last week I said I was going to declutter and continue selling stuff. And I got to say, I look around my office now, I've been gradually making my way from the door to my office sort of like back. And there is a huge part of my office that is just open and clean.
Elise Hu (42:57):
That's
Doree Shafrir (42:57):
Great. As I was doing it, I was like, "Oh my God, I still have so much more to go. " And then this morning I was like, "Oh, it's like so much better." It really hit me that at least this half of the office is so much cleaner. There's just not stuff everywhere. And I was like, "Oh my God, I'm doing it. " There
Elise Hu (43:20):
Really is something to the incremental change or the daily habits are what leads to big change. It's never like one big change. It's little
Doree Shafrir (43:28):
Incremental
Elise Hu (43:28):
Steps.
Doree Shafrir (43:28):
But I think for us, we needed the big change. We needed the shock and awe of cleaning our house. But I was saying to Matt, we've kept it clean for over a month. That's great. The bad habits have not crept back in, which feels really, really, really good. This week we're having people over again.
Elise Hu (43:47):
Oh, fun.
Doree Shafrir (43:48):
We're going to do a Seder. We're going to have one of Henry's friends and his parents. And actually, I'm good friends with the mom, so that'll be nice. Yay. Good. Yeah. So we're having another time, people coming over to our house. Hosting again. Great. Yeah, hosting again, which didn't happen for a very long time. So just kind of getting prepped for that is my intention for this week, but we don't have to do a full house cleaning.
Elise Hu (44:14):
No, you don't because it's already done.
Doree Shafrir (44:16):
It's already
Elise Hu (44:16):
Done. It's already done.
Doree Shafrir (44:17):
How about you, Elise?
Elise Hu (44:19):
Last week I said I wanted to try something new and I didn't mean skydiving or anything. I just thought maybe I would try a different cycling class or try a cycling class, which I haven't done in many years or something. Oh, I did do one thing. I have l up in one way, actually, Dora, and I just thought of it.
Doree Shafrir (44:37):
Okay.
Elise Hu (44:37):
I usually don't drive by myself longer than three hours or three and a half hours. Oh, interesting. But because we wanted to have Oscar with us for spring break in Scottsdale, I drove the girls and the dog all by myself for six hours. So I did something I've never done before as an adult. So I did that for myself, which was good actually. That was the one new thing. Cool.That's one way that I l up. I needed a lot of encouragement because I just thought I'd be so bored and I never want to be in the car that long, but the girls were awesome and entertaining and we played the alphabet game with the license plates and I listened to Chanel Miller's memoir. I know my name.
Doree Shafrir (45:18):
Oh, cool.
Elise Hu (45:18):
Which is very good. She does it herself. And I haven't finished it, but that was really gripping. So that's my one thing that I did that was new. And then Oscar's done something new. He's gone swimming and Ava's done something new. She went on an international trip to Latin America, to South America without the rest of her family at age 13. We're so proud of her. And then the younger girls did all sorts of really tricky slides, like big drops that launch you high up in the air at the end. And so they did some, they really l up too. So feeling very robust and rich. My life is very rich. So this week it's just to be present. My intention is just to be present because we're going to return to work after break. And then I'm sure I'm going to be harried because after every break period, things pile up and then I get stressed out because I have to catch up on everything that I put aside.
(46:13):
And so it'll be a real challenge just to like sit at all the meals and talk to everybody without having my head in another place. So I'm just intending and putting it out there to just kind of be there and be present and give my attention to whatever's right in front of me.
Doree Shafrir (46:30):
Great. I love that. All right. Well, this is also the episode where we thank our Patreon supporters at the $10 level or above. So I will read the names of these wonderful supporters. Thank you to Alvin, Ariel C., Laura, Ciconi, Sarah Liska, Felicia Justice Byro, Jasmine DeJesus, Christie, Caitlin H, Katie, Ashley Taylor, Theresa Anderson, Nicole Gass, Maya, Barbara C., Amy, Amy Schnitzer, Megan, Shelly Lee, Sarah Buzi, Alison Cohen, Melissa McClain, Jackie Leventhal, Fran, Kelsey Wolf Done, Laura Eddie, Gentle Apte, Valerie Bruno, Julie Daniel, E. Jackson, Alicia, Katherine Burke, Amy Moseko, Liz Rain, JDK, Hannah M, Julia P, Maddie O'Day, Marissa Sarah Bell, Maria, Diana S-T, Coco Bean, Laura Haddon, Josie H, Nikki Bosser, Juliana Duff, Chelsea Torres, Tiffany G, Stephanie Germana, Olivia Fahey, Elizabeth A, Christine Bassis, Jessica Gail, Zulima Lundy, Carolyn Rodriguez, Carrie Golds, Anne T, Katherine Ellingson, Kara Brugman, Sarah H, Sarah Egan, Jess Combin, Jennifer Olson, Jennifer HS, Eliza Gibson, Jillian Bowman, Brianne Macy, Elizabeth Holland, Karen Perlman, Katie Jordan, Sarah M, Kate M., Josie Alquist, Tara Todd, Elizabeth Cleary and Monica.
(47:59):
Thank you all so much. We are so grateful for you. Anyone still listening who is not a Patreon supporter, please support us at patreon.com/Forever35. And just a reminder that Forever 35 is hosted and produced by me, Doree Shafrir and Elise Hu and produced and edited by Samee Junio. Sami Reed is our project manager and our network partner is Acast. Thanks so much everybody. Bye.