The Melanie Avalon Biohacking Podcast Episode #349 - Dr. Trisha Pasricha

TRANSCRIPT

Dr. Trisha Pasricha
normal to not be what you think is normal. You don't have to go once a day. You don't have to go once in the morning to be normal. Normal just has to be two things in my books. One of those things is it should be comfortable for you. You shouldn't strain. It should be effortless. That's one criteria.

And then two, it should occur at socially appropriate times. I actually like think this is like the secret of highly successful people. I'm not kidding you. Like, you know, everyone's like, oh, highly successful people, they make their bed every day. No, I think they budget time to poop every day. But they're just, that's not the one that makes it to like Forbes magazine. But I think that's the secret. Welcome to

Melanie Avalon
to the Melanie Avalon Biohacking Podcast, where we meet the world's top experts to explore the secrets of health, mindset, longevity, and so much more. Are you ready to take charge of your existence and biohack your life? This show is for you. Please keep in mind, we're not dispensing medical advice and are not responsible for any outcomes you may experience from implementing the tactics lying herein.

So friends, are you ready to join me? Let's do this. Welcome back to the Melanie Avalon Biohacking Podcast. Oh my goodness, friends, you're in for such a treat today with Dr. Tricia Pasricha. As you guys know, I love talking about bowel movements, including how to troubleshoot them and how to optimize them. And today's episode just might blow your mind. I cannot recommend her book, You've Been Booping All Wrong Enough. And as you will see, yes, Dr. Tricia is a professor at Harvard with a weekly column in the Washington Post. Basically, she's super legit. You are going to learn so many fascinating things, including what is the secret of highly successful people. And yes, it might relate to your bowels. Just how bad do people perceive the experience of constipation? What actually is normal when it comes to your pooping habits? How should you poop in the bathroom? And should you actually get a bidet? I was kind of sold on bidets with this conversation, so I might be looking into that soon. The role of fiber in your bowel movements, how much do you actually need, and is going carnivore or super low-carb a problem? The true cause of hemorrhoids, how to poop when you're traveling, and so much more. These show notes for today's episode will be at melanieavilon.com slash pooping wrong. Those show notes will have a full transcript as well as links to everything that we talked about, so definitely check that out. I can't wait to hear what you guys think. Definitely let me know in my Facebook group, IF biohackers, intermittent fasting plus real foods plus life. Comment something you learned or something that resonated with you on the pinned post to enter to win something that I love, and then check out my Instagram, find the Friday announcement post, and again, comment there to enter to win something that I love. All right, I think that's all the things. Without further ado, please enjoy this fabulous conversation with Dr. Tricia Paz-Richa. Hi friends, welcome back to the show. I am so incredibly excited about the conversation I'm about to have. It is on one of my favorite topics that I talk about all the time, probably more than most people, and with the most incredible guest and person to talk about this for their incredible book and all the things. So here is what we are doing. I am here with Dr. Tricia Paz-Richa. She is the author of a book called You've Been Pooping All Wrong, How to Make Your Bowel Movements a Joy. She is an Associate Professor of Medicine at Harvard.

Melanie Avalon
She writes the Ask a Doctor columnist for the Washington Post, where she translates complex medical topics into must read insights every single week. She is also a graduate of Harvard herself. She has a medical degree from Vanderbilt University School of Medicine, a Master of Public Health from the Harvard T.H. Chan School of Public Health, and she is currently a director at the Institute. Oh, she is the director at the Institute for Gut Brain Research at Beth Israel Deaconess Medical Center, and many, many more things. So that is a really, really impressive resume and friends, oh my goodness.

So as you guys know, I for years and years and years have talked about my own challenges and struggles with my bowel movements and all the things, be it constipation, IBS, my intrinsic fear that I actually have had about my bowel movements and obsession and fixation. And it's honestly the reason I started going to therapy, which is probably a good thing because most people can probably benefit from going to therapy. But in any case, I clearly was very excited about reading this book and oh my goodness, it completely blew me away. So I learned so much that I had no idea about when it comes to how our bowel movements actually work, what actually happens down there, the role of the conscious input from our minds versus what is kind of on autopilot, what we can control, what we can't control. Speaking of, there's a lot in the book about how to control things if you have fears of pooping in public or with travel or whatever it may be. There's a ton of science. There's all the things about the gut-brain connection and how oftentimes we say that IBS is all in your head, but is that true? Is it actually all in your gut? Where is it? Wiping habits, I can't even, I cannot even properly summarize everything. So friends, I'm just looking forward to this conversation so much, I have so many questions. So Trisha, thank you so much for all that you do. Also, you have a really interesting backstory, so I wanna get into that. And thank you so much for being here.

Dr. Trisha Pasricha
Oh my gosh, that was an amazing introduction. Thank you for having me, Melanie. I'm delighted to be here.

Melanie Avalon
It's so funny. So like when I started reading your book, you know, you open by talking about your father who was a famous gastroenterologist or does he still practice now? He does.

Yeah. He's at the Mayo Clinic right now. Oh, yes. Okay. Amazing. Amazing. You talk about, you know, growing up, what was normal with like conversations around the dinner table. And I was just reflecting. I was like, I was like, kind of jealous. I was like, I don't know, especially given my current fixation with all things bowel movements. I was like, what would that be like to like grow up with that sort of conversation happening all the time? And then your mom was in the FBI, like so many things. I just have a really quick question, just a personal question. So did you, because I found for me, what happened with me was that I never thought about my bowel movements growing up, like at all, which is kind of similar to what you talk about in the book with, you know, I think you give an example of like a patient and you ask him like what his stool looks like or something. And he, you know, says he doesn't ever even look at it. I think a lot of people are like that. And then for me, I had this inciting incident where I got food poisoning. And then after that, things just never got back to normal. And that's when I became fixated. So my question here to like started off is, I kind of reflect fondly on the times when I didn't think twice about my bowel movements at all. It's like shocking to me because I switched into a state where I literally thought about it 24 seven to the point, like I said, I started going to see a therapist for it. So with you growing up with that culture of your family, which I'd love to hear more about, did that make you at all? It's like a pun like anal about about your bowel movements. Like, like, did that have a negative effect at all on any anxiety for you? Like, have you personally had bowel movement issues?

Dr. Trisha Pasricha
Yeah, that's a great question. We talked about poop all the time, so it was on my mind all the time. But I think the difference in what I think was positive and that I'm hoping to, you know, I have two kids, I have a two-year-old and four-year-old, is that we were just a really poop positive family. Like it wasn't like discussed in a way that at least I didn't perceive as being overly intrusive, but it was intrusive, right? Like it was like, you know, like my dad would ask us stuff like, did you go today? And you know, like other dads might be like, did you do your homework? He was like, did you have a bowel movement? And we'd be like, yes or no. And if we said no, he'd be like, why? What went wrong? What's going on? And but kind of like in just like a check-in, not in like a, you know, like shame on you, you should have pooped and you didn't, but more just like what's going on? And it was very welcoming and open and eventually just talking like this all the time.

We came to learn so much, not just about our bowel movements, but really if you get past the like, you know, like how silly and odd it is to talk about your poop, you kind of then get to open the door to talk about how cool and exciting the physiology of your gut is in general and how your body works. And all of those conversations happen most of my childhood. And I would say probably most of my childhood, I had a fantastic relationship with my bowels. I was very aware of it when I went to college and like everything about being in college for me was new and stressful and that relationship changed. And I, having grown up like really, really having a particular pattern and knowing when something was off, I could feel that like things had changed. And I spent a lot of time trying to course correct afterwards. And then when I went on and eventually became a doctor on my own, that was like several years later. I mean, I did notice this bizarre pattern. Like you're describing that there are a lot of people who never talk about their bowels. They don't really think about them. And there's two camps. There's a camp that doesn't think about them, doesn't talk about them, and it's not a problem at all. But there's this second camp, which is the kind that I saw in my clinic, which is they don't talk about it. They don't think about it. And yet it's bothering them and it's disrupting their lives, even if they haven't quite made the connection. Like, so I'll give you a really specific example. Like it's very common for me to have someone in clinic who's been like dragged in by their partner, for example. And like they'll say, I don't think I have a problem. And their partner will be like, are you kidding me? You spend 40 minutes in the bathroom. Or like you're always getting up to leave in the middle of the dinner table or like we can't go on vacation because of this. And oftentimes it's like getting a partner, it's living with someone for the first time that makes you realize that this thing, this way of life that you had, which you thought was normal, you didn't think twice about it.

Dr. Trisha Pasricha
Once you see how somebody else lives and you're like, you get really close to someone else, you realize that your bowel habits were disrupting your life. Like they were actually a bigger problem than you realize. You just didn't know because you never had a conversation with someone else and you never had like a third party to be like, wait, this is not how the rest of us are doing it. And so I had come across this statistic, which I still think about a lot, which is that 40% of Americans daily lives are disrupted by their bowel habits. And that's not necessarily people who have a diagnosis of some kind, like not necessarily people with IBS, just something about their bowels disrupts their daily lives. It's a huge number.

And I think if we were to go back to the root of how we got in that situation, it's largely because so many people don't talk about it and they don't know who to talk about with it. And they don't know the words to use and they don't have the conversation. So I am very much of the belief that I wish everybody grew up in the kind of household I grew up in where talking about it was not only normal, but it was like a healthy check in. And then then what I loved about my dad and that I hope I'm doing with my kids is that it was fun. Like it's like, first of all, poop jokes are like hilarious when you're five years old. Like my daughter loves these jokes, but also like, it's just cool to think about the science and to learn about it. And that's really what sucked me into wanting to become a gastroenterologist. So I hope that all of us start talking about this more.

Melanie Avalon
Oh my goodness. Okay. Well, I'm loving talking about it right now. So this is so great.

Oh, this is so great. Okay. I have 50 million things I want to ask you. So one question is, okay, so for example, your dad would check in, you know, asking you if you pooped that day. One of the things that was pretty mind blowing to me and very comforting to me, because I think we have this idea in society like that there's the right amount of times to go, which is like maybe once per day. And yet you share some stats in the book, like the crazy range. So like Americans anywhere from like three to seven times a week is normal, but like in Eastern India, it's like 14 times a day, or like what was the other one? Italy is around one time a day. So this range of how many times we even go, which one of the things I really liked about the book is it's very comforting. Like it makes you feel okay about both identifying what may be off and what you're doing or need to be addressed and fixed while also being comforting about like, it's okay. If you're not like the picture perfect, you know, picture of normal, like it's going to be okay. If you have to take a laxative here and there, that's okay. But yeah, so what is normal?

Dr. Trisha Pasricha
Yeah. We have this idea that normal should be one perfect sausage-like stool every day. And that idea dates back centuries. When I was researching this book, I went into these pre-Civil War era medical manuals in the Harvard archives to try to figure out where this myth came from. And we were saying even back then, medical doctors were like, if you feel you need to have a bowel movement more than once a day, hold it in. Hold it in so that you can just have one nice formed one in the morning rather than like, God forbid you have to poop twice in one day. And I see like echoes of this in clinic. Like people will come in and say, I have to poop three times a day. I have diarrhea. And to me, that word, diarrhea, doesn't apply. If you're just pooping three times a day and you're happy and it doesn't really bother you, just like the frequency of three feels like it must be so much to a lot of people. But it's actually perfectly normal and natural because your body has these spikes. Your colon has these spikes throughout the day that during which it naturally is going to contract and try to have a bowel movement. And one of those times is when you eat. And we eat usually three times a day. And it's very normal for a lot of people to have to poop after they eat. Like within a couple minutes of your stomach stretching, we have these mechanical stretch receptors on the cells lining in our stomach. And that sends a signal up to the brain, which sends another signal down to the colon to start to contract. So this is very normal. But it's true that probably the strongest signal that we'll all have to get during the day is within the first one or two hours of waking. And I think that that's how this myth took flight of once daily evacuation every morning. That's the healthiest. That's the closest to God you'll ever get. And I think everyone has stuck with that since.

And it's true that in the morning, there are a lot of these factors that kind of naturally could work together for people to have a good bowel movement. One is your colon goes to sleep at night. It works on this circadian rhythm. So it's actually very quiescent while we're sleeping. Nobody, unless you have a medical issue, wakes up to go poop. You wake up to pee all the time, or some of us do. But it's pretty rare for people to have to wake up to go poop unless there's something else going on. And that is because your colon really doesn't move much at night. But in the morning, it wakes up, and it buzzes with activity. And you get these really strong contractions that don't quite happen again for you during the rest of the day, except for these few rare occasions, like if you were to eat again. But then maybe you might go for a walk in the morning, or you might have a cup of coffee. These things really strongly trigger contractions. And then you're stacking them on top of each other. It makes sense why you would want to go to the bathroom in the morning if you can make time for it.

Dr. Trisha Pasricha
The problem is that so many of us don't make time for it. We don't budget time for it, and our mornings are totally chaotic and hectic. And we miss that window.

And then it becomes very hard to set up a pattern and a kind of regular schedule, which really the colon is not like a lot of other organs in our bodies. It loves a schedule. And the colon is this creature of habit. You know, your heart rate is going to keep on, your heart's going to keep on beating throughout the day, 24 hours, really no matter what you're doing. It might slow down at night, but it's going and going and going. Your colon's not like that. It's like you. It's going to go to sleep and it's going to respond to these cues. So it's really important to go on a schedule.

But all of this said, because all of our schedules are so different, it's totally normal to not be what you think is normal. You don't have to go once a day. You don't have to go once in the morning to be normal. Normal just has to be two things in my books. One of those things is it should be comfortable for you. You shouldn't strain. It should be effortless. That's one criteria. And then two, it should occur at socially appropriate times. Like somebody who poops three times a day after every meal and doesn't bother them, doesn't bother their partner, doesn't disrupt their work, that's completely normal to me. But there might be another person who says, I'm mortified because I have to poop like in the middle of my soup at lunch and I don't go out with my friends. I cancel brunch plans because I'm so embarrassed. Then I would say that's not normal.

And then we can think about how to help fix it. But it really depends on the individual.

Melanie Avalon
I thought it was really helpful, you had these case study examples where you have a patient and then the question is like, do you find that person normal or not? And what was really interesting about it is it showed that normal is not always picture perfect normal.

Because I remember the very first one that I read, I was like, oh, she's gonna say that that's not normal. But then it was like, no, this is a normal situation that you're describing of this person.

Dr. Trisha Pasricha
Yes. Yeah. How many of those did you get right? Did you agree with me?

Melanie Avalon
Well, I think after the first one, I was like, okay, wait, I'm picking up on this now. So I think I did better after the first one.

But yeah, so I love what you're saying about how it's on a circadian rhythm and the importance of budgeting time for that because that's also speaking my language because I literally plan in time for my bowel movements at the beginning of the day. It's budgeted in. And if I have to go somewhere and leave early, then I wake up earlier. So it's all part of my calendar.

Dr. Trisha Pasricha
I love that for you and I love that for me. I do the same thing. I actually think this is the secret of highly successful people. I'm not kidding you.

Everyone's like, oh, highly successful people, they make their bed every day. No, I think they budget time to poop every day. That's not the one that makes it to Forbes magazine, but I think that's the secret and I think you figured it out.

Melanie Avalon
I would advocate for that. I believe that because I do an intermittent fasting pattern.

So I eat in the evening, like a very large meal. And then it seems like the majority of my bowel movement happens the next day at the beginning of the day. And then I don't go throughout the day because I'm not eating. So I really have to schedule in that time. It is scheduled. And if I can't schedule it, I will possibly like not go to the thing. Like if it requires like, if there's like something that's happening earlier and I know I can't schedule in that time, I might just not go. That's how much I do that.

Dr. Trisha Pasricha
Yeah, but I think that that is natural and normal because your colon does become trained to respond to these external cues. And so having that routine, doing it the same time, the same place, the same kind of comforts all around you, that's exactly how your colon thrives. People do not thrive when they go on vacation because when you throw your colon out of their routine, that's exactly why people go four or five days on vacation and don't poop.

They don't talk about it as loudly as they should. But what you're describing, this is exactly what I do too, is setting up a regular rhythm. That's the way that your colon is able to know it's time to go, and then it does. And then you don't have to worry about it the rest of your day.

Melanie Avalon
Actually, so here's a question I'm thinking of, which is, so you said that the, and I do want to get more into the actual reflexes because there's a contradiction when it comes to, is it tension and contraction or is it relaxation? So we can get into that.

But before that, you mentioned the circadian rhythm affecting the movement, the eating of food affecting the movement. Can you, if you, I guess, artificially induce a bowel movement, would that also signal back the rhythm to the colon? And what I mean by that is, for example, say you're traveling, and so now you're in a new time zone. So the rhythm is off. For me, when I travel, the first thing I do the next day, unless I don't have to, and it's just like, it just works out. And for some reason, my bowels are cooperating. But if they're not, I either do an enema, like I literally pack an enema bucket in my suitcase, or I'll get a colonic. Does doing an external instigation of the bowel movement tell, like reset the circadian rhythm of the bowels?

Dr. Trisha Pasricha
That's a good question. The things that actually probably most strongly, researchers found most strongly resets the circadian rhythm are the external cues like light, and so melatonin plays a big role in the circadian clocks, and also eating. So we don't eat at nighttime, and eating first thing in the morning is a strong cue to your colon that we're waking up, it's time to be active. So those two things are most strong.

Using a laxative, like a stimulant laxative, or maybe an enema, those things will cause the colon to contract and it'll cause a bowel movement, but if they don't actually necessarily set you up circadian wise for the next day or the next 24 hours, you are probably doing that work yourself because you're staying up to kind of readjust to that time zone. But what I like to do when I travel is start to put myself in the mind, and I'm just like you, I'm doing all of this for my bowels, more so than I'm doing it for my energy level or for anything else. I just want to get this set. And I start to think and act and behave like I'm already in that time zone before my plane has taken off. If I'm going to Europe and I'm thinking, okay, it's 9 a.m. here, but it's 3 p.m. over there, I'm going to wait and eat, and I'm going to have dinner on the flight at noon or whatever at 1 p.m., that's going to be my dinner, and I'm going to go to sleep soon afterwards. I'm not going to watch movies when I travel, and I'm going to put my light blocking mask on. I'm doing all of this, not just so that I can have energy and be ready to go, but more because I just want my colon to start reacting and behaving like it's on this new time zone, so we are ready to go.

I mean, the other thing I do, which is I think even more important or at least just as important, is I pack just like you're packing like a clonix. I pack so much of my fiber supplement. I bring a fiber supplement along because I know when I go on vacation, I try to be good and I try to be really aggressive about eating more fiber than usual, and I think that's what we all should do, but sometimes it just doesn't happen. You're just at these fabulous places. You don't feel like you want to eat this nice kale salad when there's a bowl of pasta that you could be eating instead, so at least do the bare minimum and take a fiber supplement because you need a lot of extra help when you're on vacation because you're fighting all of these other things happening at the same time. You're probably not exercising the way you used to. I rarely drink coffee the same way that I do when I'm at home, like my whole schedule's off, so you have to catch up somehow. The easiest way sometimes is to just boost your fiber intake.

Melanie Avalon
Yeah, to that point, so the circadian rhythm with traveling, we actually have talked about this a lot on the intermittent fasting podcast because like you mentioned, light and eating, resetting everything. They've actually, I don't know if you've read it, but they've actually done a really interesting study on using fasting to reset the circadian rhythm because basically similar to what you're saying, you can use it to like not eat while traveling and then eat in the time zone that you arrived in.

So kind of similar to what you're doing, you're just doing it on the plane and that that is really effective for resetting the circadian rhythm. So I find for me, it's really helpful because since I, contrary to I guess what maybe we might have done all the time as hunter gatherers, but I eat at night so then when I travel, I don't eat until the night the next day at the new place and I find that that really helps me pretty quickly reset, which is really helpful.

Dr. Trisha Pasricha
Yeah, I think that makes sense. I also think if that's your routine, like if you want to stick to your routine at home, which always is the thing that your body is going to respond best to, then totally do what you're doing and try to recreate all of those patterns that you can, but just in the new place that you're in.

Melanie Avalon
Yes, love it. Definitely want to get back into fiber too. One other question about what normal is. So we talked about when is normal and how many times a day is normal.

But you mentioned the Bristol chart, which I am very, very familiar with. And we're listeners not like don't, yeah, don't tempt me with a Bristol chart. But for listeners, it's basically a chart that shows and most listeners have probably seen it like on the wall of a doctor's office or something. But it shows the different stool consistencies and people say to aim for the middle numbers. So is that the same thing where everybody has different normals or do we really need to be aiming for that like three, four, like middle zone?

Dr. Trisha Pasricha
Yeah, it's kind of a similar thing. Some people, on one end of the spectrum, you have these really hard, tiny rabbit-like pellets. And on the opposite end of the spectrum, you have pure soupy liquid. And I would say both of those extremes are not fun.

I've never met anybody who has these rabbit pebbles and enjoyed that poop. And similarly, I think if you're having really, really watery diarrhea, that's not pleasant either. So it doesn't have to be a perfect snake-like sausage. There can be variation within there. But I do think you want to have some kind of consistency to it. But that said, there's a lot of leeway there. And what I tell people all the time, because one of the things as a gastroenterologist, we're always counseling people on is to increase their fiber, is that when you start to do that, you're going to naturally start to poop more. And it's going to be softer. It's going to be slightly more mushier than maybe what you're used to. And that's totally normal. It's not that now suddenly you have diarrhea necessarily, unless it's bothering you and you're becoming so bad that you're dehydrated. But it's really just a function of you eating more fiber. And rather than look at that and say, oh gosh, this is diarrhea. This is a problem. Say, wow, this is great. This is a representation that I'm eating more fiber. And it's reflecting back at me. And you should embrace that, new you.

Melanie Avalon
Yeah, it's interesting, at least for me, because I mentioned having the gut issues started after the food poisoning, but I went through a period of time. I don't even know how long it was, but I was severely constipated.

That's what started all my neuroses around this, because I just felt so toxic that I developed a complex around it. So now I find I'm much better with everything that said, I find that when I see that Bristol stool chart, I even get anxiety looking at the... I err on the side of being more on the loose side, because I have such a fear of being constipated that any day I would rather be things moving. Even if I have to go to the bathroom more, I just am so averse to being constipated. I think you said something in the... Did you say something about a woman who had... She had some sort of tremors, I think, and she said that she would rather have her tremors than be constipated. I was like, I know, I hear you. So I guess what I'm asking is, is that a problem that I encourage things to be more loose because I'm so scared of being constipated?

Dr. Trisha Pasricha
No. Well, I mean, I think it sounds like you've had a long journey with this. And it's kind of a classic story that you've described in a way that a lot of people have some infection. Maybe it's far a little bacterial. We don't always quite know. But like food poisoning, people estimate it's between one in three or one in four people who get food poisoning, like an infectious diarrhea, will go on to develop IBS. And depending on that person and their own neurons and what they're bringing to the table, it might be more on the constipation side, it might be more on the diarrhea side. So we see all of it and being constipated is so miserable. It's like truly one of the most miserable, I think, human experiences. And it's really underappreciated.

It's not just me saying that, are you saying that? It's there in the literature that people with Parkinson's disease, which is something I study, if you survey them, they would rather give up their Parkinson's tremors than live with that severe constipation. And in IBS, your double bowel syndrome, researchers have asked people who have IBS, people would give up sex in order to be able to have good bowel movement. That's how intense this is.

But for something that we don't talk about, we feel embarrassed to talk about out loud. So I can understand entirely why you would never want to be feeling constipated again, and you would rather err on the side of loose stools. And I think, again, it's what's comfortable for you. There are some people who would rather have a harder, firmer stool. And as long as they're not straining too hard and it doesn't bother them, and that's what they are comfortable with, I can live with that. I can live with a whole range of normal, as long as generally people's habits are healthy and don't interfere with their enjoyment of their daily life.

Melanie Avalon
Which which is what you call. I haven't haven't said the word out loud so poop for ya. I guess it's the

Dr. Trisha Pasricha
That's right, poo for ya, that's exactly what I want everyone to live and experience.

Melanie Avalon
movements, so that's having comfortable movements and having socially appropriate movements.

Dr. Trisha Pasricha
Yeah, and just not thinking about them. But I want you to not think about them and truly be living a life where they're not bothering you.

Your bowel movements are not this thing that weighs you down because you haven't gone that day or you're not joining your friends when they're all going out. You can't go and take a new class that you want to take because of this. It should just be something that happens effortlessly, quickly, however many times a day it happens for you and then you go live your best life.

Melanie Avalon
love this. I love this.

And actually, okay, so because we're talking all about, you know, a person's perception, okay, a person's bowel movements and what's normal, and then their perception and experience of that. And something I found so fascinating in your book, and it was something I was a little bit aware of, but I hadn't read the, like I hadn't learned about the actual studies on it, which was I remember, you know, being told that for people who oftentimes who experience bloating, for example, who say they experience bloating, that they'll do tests, and they're not technically like any more bloated than other people who are not feeling the bloating. And I remember when I first heard that, I was like, well, that's upsetting because I do feel bloated. So don't tell me it's like all in my head. And then you talk about these studies where basically the people who are experiencing that, like they are feeling it more than the other people, right? Like they are actually feeling it more. But it's your brain perceiving it. So what's happening there? So when people who seem to be hypersensitive to what's happening inside, what's the cause of that? Is that coming from their intestines? Is it coming from their brain? Like, why?

Dr. Trisha Pasricha
Yeah. In the bigger picture, when we talk about irritable bowel syndrome and or bloating or a lot of these disorders, sometimes they get framed as a problem of how the gut and the brain communicate. And that's what I study. And I think if you just leave it there, that sounds really, really vague. And it's very, very confusing.

And it's kind of this like way that I think a lot of people say, oh, okay, this is about my brain. Therefore, maybe it's all in my head. And all these tests are often normal, too, right? Like we'll do colonoscopies, we'll get biopsies, and these things are all normal. And once we start to invoke the brain in the conversation, it becomes very easy for people to say, okay, well, it's because this person is stressed. And often that person is a she and she needs to take some anti-anxiety medicines or something like that.

And what's interesting is that if you dive deeper into the chemical and the molecular mechanisms about what happens with our perceptions of pain and discomfort and hypersensitivity, like you mentioned, they have to start somewhere.

But by definition, they also have to pass through the brain, or we wouldn't perceive anything as uncomfortable if that signal didn't eventually reach the brain. And in the case of irritable bowel syndrome, sometimes the signal goes awry at multiple different levels. There's a problem with the nerves in the gut. And remember that the gut has millions of neurons or nerve cells just like we have in our brain, but they're spread out through our colons, our small intestines, our stomachs, and we call that network the enteric nervous system. And what we think happens is there's some often inciting event or maybe a series of inciting events. Oftentimes it happens early on in life. It's a classic scenario is someone says there was some traumatic, either physically traumatic or maybe emotionally psychologically traumatic event early in childhood. Or perhaps there's an inciting event like you've described in your case, which we see very commonly like a big infection.

And maybe it doesn't even feel so big to you at the time. Like with COVID, we had a lot of mild cases where they were like, yeah, I felt like a mild cold, but then that's what triggered IBS. So some inflammatory event or trigger happens. And those nerve cells that are in our guts become sensitized, meaning it takes a lot less going forward for them to react. And when this happens earlier on in life, it's partially because those nerve cells haven't yet formed and fully matured. And so they start to then say, this is the new normal. This is the level at which we should react. But when you're older, it can still happen as well. And those nerve cells then will start to react even to normal types of movements that happen within our body all the time that we don't think about. That for other people is just the sensation of gas passing through the body or food that's on its way. Most people don't feel those things, but you, if you have IBS and your nerve cells are reacting at a much lower threshold, you're going to feel all of those movements.

Dr. Trisha Pasricha
And it's going to be very uncomfortable to have a bowel movement where you're pushing a lot of stool out. And that signal of something triggering those nerve cells then has to go through your spinal cord up to your brain and your brain perceives it as painful. And then oftentimes what happens is, especially in these chronic conditions with IBS, you get triggered enough all the time, multiple times a day, that of course it makes you hypervigilant. It makes you worried about your symptoms. It makes you worried.

When is this next trigger going to come? And you start to say, I never want to live like this again. As you describe, you start to fixate on your bowels. And then somebody from the outside just comes and looks at you and they're like, wow, this person, all she does is think about her bowels. That's the reason she has symptoms because she's thinking about them too much. And it looks like the problem is in your head when that is not the case at all. It started inside your gut and it just formed this vicious cycle that cannot be detected on standard tests, but has been detected. We know how to detect it through special stains and looking for the right types of nerve cells, but it's just not something that we do in a typical colonoscopy, but we know it's there. Wow.

Melanie Avalon
Okay, yes, I find this very validating from my experience. Although important clarification, because I realize I say that I have IBS, however, and you're talking here about nerve cells, and you mentioned the word pain, I remember, didn't they change the definition of IBS a few years ago, where prior to that, and I could be wrong, but prior to that, it did not include having to have pain, and then it did?

Is that, I just know that, so I actually don't have pain, I just have bowel, and like I said, I manage it pretty well, but I have what I consider to be IBS, and that I feel like it's not pouforia, like it's not like the effortless, easy bowel movement, but I don't actually have pain, I just have distress over bloating. So does that technically not qualify as IBS?

Dr. Trisha Pasricha
I will say I think all of these conditions are on a spectrum and how we define IBS based on symptoms does change every couple of years. And that's like a whole separate conversation.

But yes, at one point, it usually does involve discomfort or pain to be called IBS. And at one point we were saying it has to be pain or discomfort that's relieved with the bowel movement. Now we're saying it's pain or discomfort associated with the bowel movement before, after, during any kind of link to bowel movements. And we're actually going to change the definition probably sometime next year. So we might throw all of that out the window. I know. To what? Even I don't know. The gods, powers that be are going to change it. But I think it, to me, how we change it based on people describing their symptoms isn't. And then there's a cousin of IBS, which we might call functional bloating, which focuses more on the bloating symptoms. But they're all very closely linked and people with IBS often have a lot of bloating. People who have a lot of bloating often struggle with their bowel habits, even if technically the criteria don't overlap. So to me, all of these words and the names of the disorders are less helpful than understanding the pathophysiology and meaning what, what is happening at the level of the nerve cells, what is happening molecularly. And that's not how we're clinically defining these conditions yet. But I think in the next 10 years, we're going to see a shift where we're going to be able to start changing and defining them really based on what's actually going on, not just based on. In the last three months, did you think your bowel movements were associated with more bloating than discomfort? Like when these two things are on a spectrum and they're going to change with time and we're even changing the definition with time. Okay.

Melanie Avalon
So actually, that's kind of similar because you have this list of common myths and one of them was that there's a single definition for constipation, for example, but people define it all different ways. Speaking of the fiber, so I'm always really interested to learn about what the recommendations are for increasing bowel movements or optimizing bowel movements.

And you mentioned fiber and psyllium husk specifically. And I know, okay, so for me, when I was in my constipation dark phase, I definitely went through a period where I was like, okay, try all the fiber. So I definitely tried psyllium husk, but I also tried it in a time when I was trying a lot of different fibers and nothing was working. So I kind of wrote it off. And I also kind of got a fear of fiber because my experience was that, okay, I'm like eating all this fiber and nothing's coming out. So that's just kind of, that's like so dramatic to me. So is there something magical about psyllium husk compared to other fiber types? And what is the role of it in supplemental form versus having like a high fiber diet from like whole foods?

Dr. Trisha Pasricha
Well, the shortest answer to that is that is always better to get your fiber through whole foods than it would be through any one source like psyllium husk. And that's because, as you know, as everyone knows, that there's more to constipation, there's more to healthy bowel habits than just fiber. Fiber plays such a big role, but it's really all these other phytonutrients that work together in these combinations that you just can't necessarily distill. But that all of that said, if you're not meeting your fiber goals through your diet, which 95% of us aren't, I take a psyllium husk supplement every day for the days that I don't make it.

And I try really, really hard to exceed those fiber goals. But if I don't, then I know I have this. And what makes psyllium husk special is that it's basically, it should just be this ground up powder. I look for forms that just have this one ingredient, just the psyllium. And it's a soluble fiber, which means that you have to drink it in liquid, like at least eight ounces of water. I'm a little odd. I put it in my coffee. I don't necessarily recommend that for everyone because you have to chug that coffee or it will turn into a gel. That's what it does. It's a soluble fiber, so it turns into a gel. And it's that gel that you want it to turn into when it hits your small intestine because that gives you two things. It can add bulk to your stool. It can loosen it up, soften it, and make it easier to pass through. But also, if you have diarrhea, it can also pull it together and hold it together and actually conform it. So it's this shape shifter. And it actually helps for people who have diarrhea. It helps for people who have more constipation. And it does something else, too, which is that because it's a soluble gel, it can help lower the cholesterol levels in your body because it traps bile salts, which are produced by your body. And then your liver has to create more of them, and it draws cholesterol out of your bloodstream to do that. So it's great for your heart. But then what's interesting is that as that stool that has the psyllium passes along through your small bowel and now it makes its way into the colon, psyllium is one of those prebiotics that your microbes really like to feed on and ferment. And why psyllium seems to work well in conditions like IBS or other types of conditions is partially because of what it seems physically to be doing to your stool form, but partially also probably because of what happens when the microbes ferment it. So the idea is that when the microbes ferment psyllium, they're producing certain kinds of short-chain fatty acids that seem to change the properties of the nerve cells right there in the colon. And it seems to raise the sensitization levels, and it seems to change how they react then to other inputs. So you do get this physical change in your stool when you have psyllium husk, but then you get these other benefits that take a little bit more time to work, but that seem to do with these anti-inflammatory properties and possibly related to neuroinflammation even within the gut itself.

Melanie Avalon
I love this. I've been, I've been going down a rabbit hole with short chain fatty acids. I think, I think that's going to become something that we hear more and more about just as how, you know, how they function as signaling molecules for, for so many things in the body. So okay, I love that.

What do you think about the, so there, it's funny because there's an entire carnivore movement, you know, zero carb where people are just eating meat essentially, which I actually did do for quite a while. They all reference this one study that it has like eight people in it, but it's like the study they use to show that a zero carb diet is ideal for bowel movements. Because basically in the study, it was like, and I've spent a long time since I've read it, but I've read it so many times because it's always referenced, but it's, you know, like just a handful of people, but they all had constipation, functional constipation. And then it resolved completely when they went on a zero carb diet. So we'll probably carb, but zero fiber diet. So what do you think about that? People who are doing like carnivore, not having any fiber, if they're not experiencing, you know, bloating or pain or a perception of bowel movements being an issue, how do you feel about that people living that lifestyle?

Dr. Trisha Pasricha
Yeah, it's really popular. I see people come to my clinic often too.

This carnivore diet is popular. And what I would say is that it's true that when people eat a lot of fiber, and especially if they're not used to it or they're kind of ramping it up a little quickly, people often feel ill because fiber is going to cause bloating. It can sometimes cause a little bit of loose stools or what people perceive as diarrhea. And you take that out and people often feel better in the short term. And even the bowel habits, it's hard to say whether they had constipation because of anything to do with fiber. We've hinted that constipation can be due to low fiber intake. And sometimes that's a fix, but it's not the only fix and it's not the only cause. And we know so many people, a lot of people probably listening who have tried in taking their fiber and ramping up their fiber intake and it didn't fix it. So in the case of this study, it's hard to know whether fiber really actually was anything related to why those people had constipation. But the problem is that if you eat these types of diets in the short term, you may feel better, you may enjoy it, you may have no symptoms from it. But in the long term, there's a real concern about the kinds of damage that you might be doing to your gut lining and to the kinds of microbes that inhabit your gut. And we talk a lot about this in the gastroenterology literature. I imagine probably everybody can agree that processed meats are something that we know is very pro-inflammatory. When I tell my patients that even red meats, like, yes, even the organic grass fed beef, these foods have shown this signal in epidemiological studies to be linked to an increased risk of colon cancer. Maybe not to the same degree, certainly not to the same degree as processed meats, but the signal is there and it's been repeated multiple times. That's a hard message to hear because we all love red meats in this country and it's a big part of, it's a dietary staple. Everybody gets around for barbecues in the summer. It's part of the culture and it's hard to take that away, especially now with the carnivore movement being on such a rise. But I worry about this one because we're seeing such a rise in early onset colorectal cancer cases that worries me every single day, to be honest. I see this in my own clinic. And while those cases are not only being driven by higher red meat intake or processed meat intake, it's part of it. It's a part of the problem. It's a problem that we can identify and recognize. So I try to counsel people, not necessarily to say, never eat red meat again, by no means, but just to try to limit it to no more than maybe three servings a week, which is a big deal for a lot of people who are used to eating a lunch meat sandwich every day, for example, or people on that. So it doesn't have to be all or nothing by any means, but for me, the data is convincing enough. I don't fully abstain for meat either. I'm not vegan necessarily or vegetarian. I eat red meat from time to time, but I don't eat more than three servings per week, mainly because I find that data so convincing.

Melanie Avalon
Do you know the, like the Inuit, I guess they would be the population that would be closest to eating like a primarily like meat and fat diet. I know they get a lot of the diseases of modern civilization when they adopt a Western diet, but do you know if they have any colon cancer before they switch over to...

Dr. Trisha Pasricha
modern? That's a great question.

I do know that in minority populations, there often is a higher rate of cases of colon cancer, but sometimes it's more of a detection issue. So actually, it's a good question. I'd have to look into it.

Melanie Avalon
And also, just while we're talking about the fiber, did you see that study, when did this come out? Maybe like a year and a half ago or so, it was the one that was looking at fiber versus fermented foods.

Oh, yeah. Yeah. I was wondering if you had thoughts on it because it basically found that fermented foods seem to have a beneficial effect, but not necessarily fiber when people added it supplementally to their diet, or I think it was like a high fiber diet versus like a high fermented food diet.

Dr. Trisha Pasricha
The study I'm thinking of, and you can tell me if this is the same one that you are, there was a study that came out of Justin Sonnenberg's lab at Stanford where they had two groups who were both eating high fiber, but one of the groups were also told to eat fermented foods. Is that the study you were thinking about? Maybe. What were the findings of it? The findings were, and I think they did it for about eight to ten weeks, something of that time frame, where they told that second group, just increase your fermented food intake as however you can as much as you can. At the end of that study, they found that the group that had been eating more fermented foods had lower inflammatory markers in their blood.

Yeah, that was it. Yeah, I think that's the same one. I do talk about that study often as a way to say that I think the introductory course that I give my patients who are meeting me is let's just ramp up fiber intake however we can because that is the number one and two, three thing that we're probably not getting enough of in our diets. That's what I see very commonly, and it's true. Most people don't get enough. But if you want to take it to the next level, then the 102 level course is I say let's start to increase the diversity of fiber and plant-based sources in our diets. Rather than just eating the same foods every day or just taking one psyllium husk supplement, now it's time to say what are all the different whole food sources I can get and try to optimize that. Then the third thing I do is fermented foods. Fermented foods, because of that, largely because of that study and those findings, they independently have extra added beneficial properties because the fermented foods by definition are introducing new life cultures that we believe are to some extent taking hold in our positive growth. Fermented foods are great. They're also something that a lot of people are just very unfamiliar with eating on a regular basis. It's often not the first thing. If we can focus on anything, I say let's just meet our fiber goals. But then if you're ready for it, I love eating fermented foods. It's as simple sometimes as just introducing Greek yogurt once a day. It doesn't have to necessarily be sauerkraut or kimchi, although I love all those things. It's an acquired taste. Eventually, you start to really like the tang of those things, but I actually think Greek yogurt is the simplest and best gateway for fermented food.

Melanie Avalon
Yeah, I've been getting more and more into it, especially learning more and more about the short chain fatty acids. And my theory is that based on a person's foundational gut microbiome, whatever they have at that moment, they might struggle with processing fiber. So I feel like people who have a gut microbiome that's ready to go and process the fiber, it's great. But for some people, they might just struggle with digesting the fiber.

And so I feel like the fermented foods are a way to gently nudge your gut microbiome that way without necessarily hitting it with, at least at once, a lot of fiber at the beginning.

Dr. Trisha Pasricha
I think it's a very common thing I hear is when we're talking and counseling people to ramp up their fiber, it's uncomfortable to do that. You get bloated, you get sick, and that's very common reaction.

And I love the idea of saying, okay, let's just work on this adjacent pathway of introducing probiotics or fermented foods. But even with fiber, I've never seen anyone go from zero grams of fiber to 25 a day daily without paying for it. You have to go low and slow and you have to work your way up because it really does take several weeks for your gut microbes to react and adjust and repopulate. So it's not like within 24 hours, you're going to suddenly become accustomed to a ton of fiber at once. Nobody could handle that. You have to go real slowly with your body and kind of let your symptoms guide you.

Melanie Avalon
And to that point, the life experience moment that convinced me, like I'll never look back, that so much of stool is bacteria or related to bacteria compared to the actual food substrates, which was, I got prescribed VSL number three, that probiotic, which is like very, very, it's like a lot of back to probiotics in there. And I took it and the amount, I actually stopped taking it because the amount of stool it made me produce at the beginning, I was probably supposed to stay on it, but it freaked me out so much that I was like, whoa, I was like, okay, so a lot of stool is bacteria.

I now know this for sure, after taking this.

Dr. Trisha Pasricha
I know, isn't that wild? We think that it's all just whatever we haven't digested, but no, it's mostly your microbes that are just living and dying in there and shedding themselves off.

Melanie Avalon
So, going to the actual, because, you know, the title, you've been pooping all wrong. So you have a very extensive overview of the actual mechanics of how we have bowel movements and toilet habits, things like that.

So, well, this book has affected me, it's been officially in so many ways. And one of the ways it's affected me now is I, now I'm literally thinking about the, when I have a bowel movement, can you talk, okay, I'll just ask a question. Can you talk a little bit about, like, the internal versus external sphincter and the role of what is consciously controlled versus what isn't? And then also, so are we contracting and creating tension or is it relaxation? It's quite a paradox.

Dr. Trisha Pasricha
It's such a paradox, and I think this is a big underappreciated part of why some people get constipation is actually a muscular problem, and really by that I mean a pelvic floor problem. So what happens in order to have a bowel movement, we have to, we all are very familiar, we have to generate what we call a valsalva maneuver, which is where we bear down. We try to basically breathe against this closed glottis, like we shut our mouths, but we kind of exhale, and that generates pressure in our chest cavity, which gets kind of translated downwards and helps, in theory, push your stool out. Well, right now, if I were to demonstrate doing that, like even my fists clench, because that's what you're doing. You're generating pressure, and you're trying to push this poop out, and that's really odd when you think about the fact that in order to have a bowel movement, you have to relax your sphincters, and yet you're clenching other parts of your body.

And what we often see happen is sometimes someone might become constipated for some reason early on in their life, like for me in college, like maybe I wasn't eating enough fiber, and I become constipated, and when that happens, you're not eating enough fiber, you learn, you train yourself, you have to strain a little bit harder in order to have a bowel movement, and you do that day after day, week after week, eventually those muscles in your pelvic floor start to change a little bit, and some of those muscles you don't have control over, because like for your anal sphincters, by the way, you have two, you have an external and an internal, you think it's one, just from the outside, it looks like just like one little butthole, but you have two, and you and I can consciously clench that external one, and it'll kind of shut everything, but the internal one we have less control over, and that's the one that sometimes becomes overwhelmed and gives up, and like sometimes people have accidents, sometimes it decides I'm too nervous, I'm not going to open up, even though we're like, we really need to go, we need to let this poop out, that internal sphincter doesn't feel safe, it doesn't relax, and this is a problem because if we've trained these muscles incorrectly, maybe because of some lifestyle we had in our past, even when we fixed that problem, now the muscles have become retrained, so even if I've discovered a plant-based diet later in my life, I'm eating a ton of fiber, the stool is very, very soft, now my sphincters are working against me, no matter what I'm bringing to the table, and so sometimes people benefit from maneuvers that are seeking to intervene on different parts of the pelvic floor, and sometimes as extreme an intervention as physical therapy for the pelvic floor, and that is actually something that about one in three people who have constipation that has not responded to laxatives, the issue the whole time is the pelvic floor, and that what they really would benefit from is something like pelvic floor physical therapy, and that's a huge number if you think about it, one in three,

Dr. Trisha Pasricha
because one in three people, constipation is very common, one in three people are not thinking about the pelvic floor as being an issue at all, it's something that I think a lot of times when I say, oh, you may have pelvic floor dysfunction in clinic, a lot of people, especially the men, are like, wait a minute, how can that be, I never had kids, everyone thinks pelvic floor dysfunction is a problem that women get when they have children, and that is a kind of pelvic floor dysfunction, but this is very different, you don't have to be a woman to have it, you don't have to have had kids to get it, we can get it for any number of reasons, but the good news is that it is treatable, but sometimes it's just something that develops over time because of this just bizarre paradoxical motion that has to happen at the sphincters, which is in stark contrast to the rest of what our bodies are doing.

Melanie Avalon
This is so, so fascinating to me. So it's kind of like two doors and the first door, the body controls more and the second door we can physically shut if the first one opens.

Dr. Trisha Pasricha
Yes, exactly. This will happen to all of us at some point in our lives, if not already today. At some point, you might have to go to the bathroom and it happens just at an inopportune time. That feeling is that you're like, what is this urgency? That's literally just your colon, the last part of your colon contracting. If you try hard enough, you squeeze that external sphincter closed, it will shut the internal sphincter too. It'll overcome it because the external sphincter is a little beefier and it'll shut it. Eventually, most of the time, it'll stop your colon from contracting. Your colon will say, okay, I get it. I see what you're doing. I'm going to stop. But every now and then, the internal sphincter puts up a big enough fight and it tries to let it out. Then accidents happen and it happens more and more often as we get older, partially because our external sphincters become a little bit weaker as we age. Then eventually, we're not able to hold things back as much. I know this is not the fun part of this conversation in our life, but that's what happens.

In a way, it's a good thing. The internal sphincter is very closely connected to our hemorrhoids, which are just these cushions of veins. It's a very sophisticated part of our anatomy because those hemorrhoids, which are right there by that internal sphincter, they're also what's responsible. They're not just these evil, red, puffy, angry cushions that bleed. They do that, too, when they become inflamed. But they also are there to just sense what's going on inside the bottom of our colon. They sense if we have poop sitting there. They sense if we have liquid in there or gas. They're what subconsciously triggers us to know. How do we know that it's safe to pass gas when we're sitting in a crowded room? We know it because there are these sensors on those hemorrhoids in our internal sphincters that detect that it's gas and that it's not solid. It says, okay, yeah, this is an okay time to do this. You're able to do it without accidentally pooping your pants in front of a meeting.

Melanie Avalon
Question about the hemorrhoids which leads to a broader question as well which was I found it really interesting you were saying in the book that historically we thought hemorrhoids were from a lack of fiber than they were saying it's actually from straining but then you did a study with your own patients where you looked at their their habits and you found that like being smartphone use was correlated to it so maybe it's like a time thing like how long you're actually on the toilet so my big question here is so out of all those options maybe what's going on with hemorrhoids and then the broader question is because earlier in the book you talk about how it can be beneficial for example to like read a book on the toilet like that can help people go sometimes so I'm confused or I'm interested and curious about the amount of time on the toilet and if it's spent like reading a book is that beneficial but if you're on your own is it not like what is the role of time on the toilet

Dr. Trisha Pasricha
Yeah, totally. I think the common denominator here is time. I think time is one of the most important factors to consider.

I do think fiber intake and straining play a role, but I think in our modern era, we are just all of us spending so much time more than we intended in the bathroom because our smartphones are so distracting. Like 20 years ago, like when I was growing up and everyone remembers when people used to keep this stack of old magazines in the bathroom that were like two months old, or like maybe yesterday's newspaper. You already knew what happened in the news and you're just reading to kill a minute or two.

Melanie Avalon
I had a book that I only read on the toilet and so I would read it then. The bathroom reader.

Dr. Trisha Pasricha
Yeah, exactly. I had this thing. We had these predictable reading materials. We had a comic book, The Far Side. The Far Side comic was the ideal bathroom reader. But these things would just occupy you. You could just flip through the pages, help you relax a little bit. And I do think relaxation is critical to a bowel movement because you have to relax those cinctures.

You have to be relaxed. You have to have this wave of your vagus nerve kind of simulating these contractions. And if you don't get that, it's very hard to go. So you need that. And so I think if you want to pull out a quick read, be my guest. But it's when you pull out your smartphone and you get really distracted by this endless stream of TikToks and reels, and you lose track of time and it's like 20 minutes later, that's when it becomes a problem. And it's just happening to all of us more than we like to admit. But most of us are bringing our smartphones in. That's what my study shows. And anecdotally, who's not bringing their smartphone in? And all I tell people is like, look, I'm not trying to take your smartphone away from you when you go to the bathroom, but just set a two TikTok limit and then just check in with yourself. Say, am I even focused on what I came in here to do or am I fully focused now? I'm on this fourth Bridgerton trailer and I should just get up and I should just go watch it on the couch rather than sit here with my pants down and keep doing what I'm doing. And all it takes is to just check in with yourself. But it's really what we think is happening with the time is that when you sit on a toilet bowl, you have no pelvic floor support. It's just this open donut. And like I said, hemorrhoids are just these cushions of veins. And eventually when they become... And we all have them. They're sitting there. But when they become engorged, when blood starts to fill them more and more, eventually they can puff out and become irritating and painful. And with time, with just this passive pressure of not having that pelvic floor support, if you do this day after day, maybe multiple times a day, but week after week, that connective tissue around the hemorrhoids we think weakened and eventually those veins engorge and bulge. And then that's why we saw this association with people who have spent longer time, people who bring their smartphones in, they spend more time on the bathroom and they were more likely to have hemorrhoids.

Melanie Avalon
So fascinating and then speaking of so other bathroom habits and you have a whole section on you know How to go and in the toilet, which I didn't I had no idea that to wait the guy who invented the toilet His last name was crapper, right?

Dr. Trisha Pasricha
was one of the pioneers and marketed the toilet around World War II era in England. And his name was printed on the backs of all of the toilets.

And we think that that's the origin of the famous moniker.

Melanie Avalon
Thomas, oh no, that's T.C., not T.P., which your initials are T.P., and you mentioned that in the book. Was that on purpose?

Dr. Trisha Pasricha
Yeah, I don't know. I think it was like I think you are destined for greatness when your initials are TP and your dad's a gastroenterologist.

Melanie Avalon
Speaking of, though, the habits that people have in the bathroom and listeners just go get you've been pooping all wrong now, because it has literally guides to everything. So how to go to the restroom in your own bathroom, how to do it in public, traveling, if you're exercising, all the things, it's in there.

One of the things I find really, really helpful, and I was glad that you endorse it, is the idea of raising up your legs. So I used to have the actual official Squatty Potty. Now I have some off-brand one, but just that simple adjustment is so helpful for me when I use the restroom. And even when I travel, here's my hack for people traveling, because you mentioned even elevating your legs, even if you're not at home. I have found that usually, in the majority of hotels I stay in, the little trash can in the restroom is usually the perfect size. So here's what I do, is I bring a roll of small trash bags, and I just use those. It actually makes it a lot easier to keep the room clean. And then I flip over that trash can, and I use that to rest my legs on when I go to the restroom. And it works so well.

Dr. Trisha Pasricha
My God, I love that travel hack. You're totally right that even for people who would consider themselves healthy, normal bowel movements don't identify as having constipation. They've done these studies where they found that when you raise your knees above the level of your waist, everybody finds that they poop more easily. That's totally expected because we have this, speaking of the pelvic floor, we have this other muscle in that pelvic floor called the puborectalis muscle, which is like this sling that basically chokes the tube of your colon closed. It's like your body stepping on its own hose and creating this kink. And that kink is there when we're sitting like I am right now. I'm sitting at this 90-degree angle on my chair. And that could be, in theory, a good thing when you're just sitting in meetings, going about your day. It helps to have a little bit of extra closure there. However, when you go to the bathroom, you want that tube to open up all the way.

And one simple way to do that is just to raise your knees above your waist. And you don't have to necessarily buy anything branded. A stack of books is totally fine. But it is why, in the past, thousands and thousands of years ago, people were just squatting. That is the most natural way to have a bowel movement. I have a two-year-old and a four-year-old. And if you go to daycares and you see all these kids who are in diapers, they just pop the deepest squat of their lives when they're pooping. They don't sit on a chair to poop. When you're a kid and you're trying to do it the most natural way, you know instinctively how you squat.

Melanie Avalon
Yeah, I'm having flashbacks to childhood that I barely remember, but apparently I was very difficult to potty train, like a late bloomer. I don't know why my mom talks about that.

Everyone's a little different. Mm-hmm. Which you also talk about. That's really interesting. That's another tangent. But, you know, how we train children to go to the restroom and how that manifests today with bathroom habits. And so you are a big fan, which I have actually, shockingly, despite my obsession with all this topic, I have never used a bidet.

Dr. Trisha Pasricha
Duh! Oh my gosh, your life would change! So I hear from your book.

Melanie Avalon
So, why should people consider possibly getting up a day?

Dr. Trisha Pasricha
Yeah, a bidet is like one of those things. It actually doesn't totally surprise me that you haven't tried one. I feel like the bidet is like the last frontier. I could convince somebody to eat fermented foods before I could convince them to get a bidet sometimes because people are, this is just like not something we do that much in America.

Like Japan, Europe, they have this like down to a tee, down to a science. But here it's like such an odd concept to people. But just to explain what a bidet is, why I think it's amazing is a bidet is just a nozzle. It's just not like the simplest form of it is just a nozzle attachment that can be cheap. Like you could buy it for 30 bucks. You can install it yourself. It attaches to your own clean water supply and it just sprays the area. And what's lovely about this and then I'll say there's like another range. There's another like a full blown. The elite. Yeah, like a heated seat and the water should be warm. I want a Gucci bidet. Yeah, it's like a magical experience and like there's air dryers built in. All of that's great. And then like in a Boston winter, it's a wonderful thing, but it doesn't have to be, you don't have to like splurge 600 bucks for this. But what's great about it is that one, people feel cleaner.

And there have been studies that have shown that like the hands of people who use bidets after they poop versus the hands of people who wipe after they poop are much cleaner. That's like not that surprising. There's just like 10 times fewer microbes on those hands when you use a bidet. And you know, it's like if you get poop anywhere else on your body, you usually don't just like wipe it off with a paper towel. Like I, I wouldn't do that if I'm like changing my kids diaper. I get a little smear of poop. I'm not just going to wipe it off and move on. I'm going to go wash my hands. But we do that for our butts for whatever reason, but even the hygiene thing, like, you know, that's kind of like a personal preference. But there are actually a lot of populations that I think would benefit from a bidet. They just haven't had the opportunity because they don't even really know what they're missing out on. But for example, like women, especially postpartum, they have a lot of inflammation and swelling there. A bidet is the absolute best.

Like if you are on your period and a lot of women have like either having these like bloody periods and they also have severe diarrhea during their periods, that's very common. A bidet just like helps you feel fully cleaned. A lot of men and women for that matter kind of have hairy posteriors. If you have a lot of hair back there, you often don't feel like just wiping really gets the job done. Like but a bidet will totally get the job done. So there's just like an endless number of people who would benefit. And like I mentioned earlier on, a lot of my patients have Parkinson's disease or have trouble with movement and balance. A bidet is a great thing because you don't have to reach back there and do a lot of manipulation.

And it's really like more of a lifestyle thing. It's like one of those things that you feel so weird about.

Dr. Trisha Pasricha
It's such an odd concept. And then when you just try it once, it's funny. Like I've never met someone who tried a bidet and was like, it was fine. I could take it or leave it.

Like people tend to have very strong positive reactions. Like once you get a bidet, you have to tell everybody you know about how great your bidet is. Like people who have bidets can't shut up about them. And it's like it's just like so odd. I'm obviously one of them. But it's like you never, I never meet people who are neutral about it. So it's like, you know, don't knock it till you try it. And once you try it, I think you'd even surprise yourself about what you learn about how amazing they are.

Melanie Avalon
are. Okay, I'm definitely, definitely looking into this and I will report back and then I will be shouting the phrases from the rooftop as well.

Well, speaking of Okay, here's something fascinating. This, this is one of the most fascinating mind blown moments I had when I had the realization, speaking of toilet paper, which by the way, you have a lot in the book about your thoughts on toilet paper and you know, two ply not one ply I feel bad because okay, I use like sustainable bamboo toilet paper, I realized that might be a little bit more problematic because of the softness factor. However, the brand I have is not that bad. And I've realized I didn't realize this until reading your book. But now looking at my own habits, I do the dabbing method, I don't do the wiping method.

Dr. Trisha Pasricha
Good for you. I love a dab. I think everybody should be dabbing.

I think we overestimate how sturdy that skin is. That skin is so delicate. In our butts, we think it must be so firm, like the back of our hands. It's not. It tears easily. We really need to be quite gentle with it. The less you can manipulate and touch it, if you could use water and use a bidet, that's even better. But otherwise, just dab it away to the extent that you can. That's not always possible. I get that. Sometimes if you have a really liquidy bowel movement, get yourself clean, but maybe just take a shower instead at some point.

Melanie Avalon
Yeah. And to this point, so this was not in your book, but this was mind blowing to me. I had a conversation with a friend. I don't know how this conversation started, but we were talking about whether or not you fold or... Sorry. Yes. Whether or not you fold or wad toilet paper. Oh my God. I love this conversation though. And we had a massive realization because we started asking everybody in my family. So that's male and female. And I will die on this hill. It looks like men fold and women wad. And I have a theory for why this is, but I don't know if you've had this realization.

Dr. Trisha Pasricha
Interesting, I'm curious to know what your theory is. I'm a folder, now that I'm thinking about it. I am a folder, but you tell me.

Melanie Avalon
I have like an explanation for why you might be a folder. But my theory, actually, I think I might have realized this with my male co-host on my podcast, and then I started pulling people. But my theory is that for, okay, women, unless they're using a bidet, which most people are not yet, but we'll work on that. My theory is that women, we have to use toilet paper for all like movements for urination and for defecation. So we're always using toilet paper.

It's not like a moment for us. But for men, like they don't use toilet paper when they're urinating, only when they're having a bowel movement. So I think they just take it more like it's like a more ceremonial thing. Like they are ritualized. Yeah. Because I promise you that I did, I got so many responses to my poll and like all the men were folders, and all the women were waters. It's mind blowing. And I'm guessing with you, however, because you have this whole, you know, like you're very much aware of like the dabbing and the sensitive tissue, you know, it's probably more if you were to use it.

Dr. Trisha Pasricha
I think it's because I'm treating it more delicately, I'm like thinking either but I think you but I also think that you're like great that obviously women were using it way more.

Melanie Avalon
Like all the time, so we don't have time for that.

Dr. Trisha Pasricha
Yeah, exactly. And there's just like a lot going on.

That is so funny. I actually like, I'm so curious. Like we should do a, we should publish the results of that study and like figure out what that, what it says about us. I'm down if you want to. Yeah. How, like what personality disorder do you have depending on how you fold your toilet paper?

Melanie Avalon
And yeah, so and there's so much more we could talk about it just as like a hint I won't I won't even tell listeners the answer so that they have to get the book to Set to know but there's a fascinating section on passing gas and who is smellier I'm not telling you the answer who does it more and Why is this so you have to get the book to find out it was fascinating?

Dr. Trisha Pasricha
Yeah, it's what's even more fascinating is that someone's done those studies like that's the best part of it

Melanie Avalon
Oh my goodness, the study you said where they had to actually like smell the different gases. I was like, I can't.

Dr. Trisha Pasricha
I was laughing. I was like, this is wild. How much would you have to pay someone, although I feel I have a feeling they did it for science. I have a feeling they did it for free.

Melanie Avalon
I don't know men are you know, I feel like some men might find that funny like they might enjoy doing that study, but

Dr. Trisha Pasricha
Yeah, I know that fart-maxing is a growing trend in a small group of people. I can see what you'd want to lean into that.

Melanie Avalon
Oh my goodness, so funny. So yeah, so this has been amazing. We didn't even remotely touch on everything. I'm just so grateful for your book and what you're doing.

And what I really appreciate and like I was saying in the beginning is like there's so much science, there's so much clarification of a lot of myths and misunderstandings out there. And what I think is most important, especially given my own experience and knowing how like neurotic I can be is that it's a very comforting book. Like it's not going to make you more neurotic, it's going to make you feel better about your bowel habits while empowering you to have the best ones that you can, including in public, which we didn't really talk about that, but you have a section on that and tips and tricks for that. So yeah, was there anything else you wanted to leave listeners with before we go?

Dr. Trisha Pasricha
I think that like one small thing, just to like take a big bird's eye view about this is that I always want people to just talk to their provider, talk to their doctor, talk to your nurse practitioner, whoever it is, before something becomes an emergency. Like, especially when we're younger, I feel like we just wait. We think bloating is not necessarily a big enough deal to bring up at a doctor's visit. Or, you know, like there's a little bit of bleeding in our stool, but it's probably hemorrhoids. You don't bring it up.

Like don't wait for it to be an emergency. Just bring it up even when it's kind of feels like no big deal to you, but it's bothering you. Because you might be surprised at how many solutions and ideas your doctor has. And then also we want to really, really make sure we're not missing a bigger problem.

Melanie Avalon
Actually, to that point, I just wanted to point out, I really appreciated how it was near the very end of the book, but you had the whole section on the importance of believing the patient. And you tell a story about, you know, when you heard people kind of talking negatively about your dad and because of how he, you know, because of the type of patients he has and he just told you basically, you know, as long as you're believing the patient, you know, that's what's important. And so I just so, so appreciated that.

And, and also to the point about talking with a doctor, it's funny because I feel like people are, like you said, like embarrassed to bring these things up. It's kind of the equivalent if you go on a sex shop and you're embarrassed, like about the workers there, but it's like they work there. Like why?

Dr. Trisha Pasricha
Yes, exactly. It's like, don't be embarrassed with me.

Melanie Avalon
getting my vibrator. They literally work here. So I just really thank you for what you're doing with believing the patient and empowering people to speak up and work with a practitioner and make change beneficially. So thank you, thank you.

I have one last question. It's super easy, but how can people best get your book?

Dr. Trisha Pasricha
Well, they can buy it anywhere books are sold and they can also follow me on Instagram or TikTok. I'm at Trisha Pasrija MD on Instagram. Perfect.

Melanie Avalon
So last rapid fire question and it's just because I realize more and more each day the importance of mindset So what is something that you're grateful for?

Dr. Trisha Pasricha
Oh, I love this question. I'm grateful for my health and for my two kids and your bidet.

Oh my God, of course, the heated bidet seat. Actually, that's like the real, that's not the necessity. That's the like want and I'm definitely grateful for that.

Melanie Avalon
I love it. I love it.

Well, thank you so much, Tricia. This has been absolutely amazing. Can't wait to like see all of your future work and studies and just thank you for everything that you do. This was really, really a pleasure.

Dr. Trisha Pasricha
Honor. This is a delight. No, thank you, Melanie. I appreciate you having me on. Well, have a good rest of your day and I will talk to you.

Melanie Avalon
you later bye thanks again thank you thank you so much for listening to the Melanie Avalon biohacking podcast for more information and resources you can check out my book what win wine as well as my supplement line Avalon X please visit Melanie Avalon comm to learn more about today's guests and always feel free to contact me at contact at Melanie Avalon comm and always remember you got this.