Beyond the Bathroom: Understanding the Mechanics of Gut-Brain Interaction

Jessie (00:00): Welcome to the IBS Nutrition Podcast, your go- to source for navigating the complex diagnosis of irritable bowel syndrome. Here, we dive deep into IBS and discover the power of diet and lifestyle to find freedom from your IBS symptoms. Whether you’re newly diagnosed or have been managing IBS for years, you are in the right place for relief. I’m your host, Jesse Wong, FODMAP dietician and a gut expert. For years, I suffered from debilitating gut symptoms that kept me out of work, feeling constant discomfort in my body and anxious around food. Today, I’m in control of my IBS, able to eat the food I love again, travel whenever I want and spend quality time with loved ones. It is my mission to help you do the same and transform the way you live with IBS. Let’s get started. Hi, everybody. Welcome to another episode of the IBS Nutrition Podcast.

(00:54)Today, we have a guest, and I will tell you, she’s probably a face you have seen, and both her and her dad are GI doctors, but she just wrote a new book, and one of the chapter she opens with, My Mother Works for the FBI. And that just blew me away. So her mother is a real deal here, but let me introduce my guest, Dr. Trisha Pasricha. MD, MPH 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 earns her medical degree from Vanderbilt University School of Medicine and a Master of Public Health from the Harvard T.H. Chan School of Public Health. Her training includes an internal medicine residency at Johns Hopkins Hospital and gastroenterology and motility fellows at Massachusetts General Hospital.

(02:02)Currently, Dr. Pasricha serves as director of the Institute of Gutberry Research at Bath Israel Deakiness Medical Center, leading an NIH funding research lab at the forefront of Gabring Science. Her work has been published in the New England Journal of Medicine, GEMA Medical Network and Nature Review. Welcome, Dr. Pasricha.

Dr. Trisha Pasricha (02:26): Thank you so much for having me. I’m so thrilled to be here with you.

Jessie (02:31): I am so thrilled that you are here. There are three topics we will dive into today before we let Dr. Pasricha talk about her mother’s story. Here are the three topics. 10 myths about pooping. It is actually in her book and there are five topics that we will dive into because I think those are really important for patients struggling with gut functions or gut issues to better understand how to better poop or what is normal in terms of pooping. And then the three piece of pooping. How pooping actually works. If you don’t understand what the mechanism is, it can make it difficult to have good bowel movement. And of course, last but not least is Dr. Pasricha’s research into the gut brain interaction, which of course IBS is categorized as a disease of the gut brain interactions. So we are all years and really want to learn more about everything you are researching.

Jessie (03:29): So let’s start with, my mother works for the FBI. What is going on here?

Dr. Trisha Pasricha (03:38): I know. That was something I used to tell people and I used to remember when I told my friend’s parents that if I was meeting them, that they stop dead in their tracks because it’s not something you hear every day. But it’s true. My mom used to work with the FBI. She was not an agent. She was an engineer. And she was actually told that she was the first female engineer to work for the FBI. And what was great about that was I had two parents who were busy and excited and very passionate about their careers growing up. So one was my dad. He is and was a gastroenterologist. But my mom, who was an engineer, is interestingly the reason that I got interested in the gut-brain connection. So if you know anyone who works for the FBI, you’ll know that they’re not actually allowed to talk about their work that often.

(04:24)And it can be very secretive what they do. And so she didn’t tell us a ton about what the day-to-day was like because she couldn’t. But when she did tell us anything about it, we all leaned in and paid a lot of potential because we were so intrigued by what she did. And one thing she talked a lot about were lie detector tests. And lie detector tests were actually my way into understanding the gut-brain connection because lie detector tests at that time traditionally used a heart rate monitor, like an EKG. And people are very good at coming up with ways to evade lie detector tests. They could make their heart rate spike for other reasons. But I knew that nobody can really mask that just uncomfortable sinking feeling in the pit of our stomach when we’re lying, or it’s kind of the same feeling we get when we get butterflies in our stomach when we’re nervous or like I used to be a theater kid, so if I blew my lines on stage, I would get this really, really bad feeling, like this canon ball sinking in my stomach.

(05:21)That feeling is something that we couldn’t measure, or at least I didn’t think we could. But then when talking to my dad, he was using this machine called an EGG, not an EKG, but an electrogastrogram. It’s a very similar kind of machine as an EKG, but it connects to the stomach. And when putting these two ideas together, I thought, well, why don’t we use this to figure out if there are these physiological changes that happen in the gut when we’re telling a lie. And both of them were very encouraging and supportive and they let me study this and give you the tools and help me do it. And I ended up finding, this was in high school that, yeah, it turns out when you tell a lie, your stomach normally does contract at this regular cycle of three cycles per minute and that rhythm gets totally thrown into chaos when you’re lying.

(06:06)It goes into this arrhythmia pattern, which basically means there’s no discernible pattern. And it fits really nicely with that lived experience that I think we’ve all had when we’re nervous. We feel these things. We just didn’t really know what it was, but it sort of explains, and then there’s been lots of other research since and even before that leading up to this that show that there’s certain molecules that get released by our brain when we’re stressed that cause that stomach to grind to a halt. And I think it’s why we a lot of the time, even though it can be nervous excitement, we feel nauseated. We feel a little sick to our stomachs. And that was what happened to me in high school. I went to the Intel International Science Fair, which I think it’s called something else now, but that used to be like the super bowl of nerds.

(06:46)And it got me really excited to go into gastroenterology and eventually down the same path my dad went down, which is neurogastroenterology or the study of the gut-brain connection. So that’s my origin story.

Jessie (06:57): That’s amazing.

Dr. Trisha Pasricha: (07:00) Hopefully not my villain origin story, just my hero, your story.

Jessie (07:02): Of course. We are so grateful for all the research that’s going into studying the gut brain interaction and giving people more tools to manage their conditions, especially when it comes to IBS, right?

Dr. Trisha Pasricha (07:12): Yeah, totally.

Jessie (07:14): Yeah. Now let’s talk about the 10 myth. Let’s start out topic number one, 10 myth. I only have five listed here. For those of you who want to hear the rest of the five, you have to get the book. And what is the name of your book?

Dr. Trisha Pasricha (07:27): Ah, you’ve been pooping all wrong.

Jessie (07:30): Do you have a copy to show us?

Dr. Trisha Pasricha (07:32): I do. It’s back here. You’ve been pooping all wrong. How to make your bowel movements a joy.

Jessie (07:38): Okay.

Dr. Trisha Pasricha (07:39): All right. Happy face. Yeah.

Jessie (07:41): I love that. I love that. All right. Myth number one, healthy people poop once a day.

Dr. Trisha Pasricha (07:47): Yeah. This is like the most common myth out there. We think that that’s the case because that’s sort of been what’s been perpetuated over generations. And the truth is that they did this study here. I work at Beth Israel Deaconess Medical Center. My colleagues did this study where they looked at Americans in this national sample who thought that they had normal bowel movements. And it turns out the answer was not one bowel movement a day is the only path to God here. Anything from once every three days to three times a day was within the range of normal. And if you think about it, that’s a huge range. There’s some people who are listening and are like, “Wait, once every three days, that is so infrequent.” And then a lot of people would be like, “Three times a day, that’s diarrhea.” And it shows you that there is a lot that could be considered normal.

(08:32)For me, the number is a little bit less important than two things. One, it should be comfortable and effortless. I have a lot of people who think they’re not constipated because they poop every day, but then when you ask them, they’re straining for 20 minutes to have that bowel movement. That’s constipated, even though yeah, sure, you’re having once a day bowel movement that you’re still constipated in my books. So it needs to be effortless for me to say that this is normal and healthy. And then two, it shouldn’t interfere with your social life in any way. It should happen at an appropriate moment that is not making you derail your activities and do the things that you love to do. And so that can be a little bit different for everyone because everyone’s lives are different. Everybody has different things going on. And so you have a big range, but if you’re ever unclear, if you’re not really sure of what’s going on with normal, always run it by your provider and they can give you like a quick gut check.

Jessie (09:22): Oh, I love that. I love that. Okay. Let’s move on to myth number two. You can become dependent on laxatives. That’s a Conversation I think we have with patients all the time.

Dr. Trisha Pasricha (09:34): Yes. This is a big one. And I know how and why this myth started. It used to be that there were these older studies of some of these stimulant-like laxatives like suna or something like that, that maybe those laxatives damaged your gut somehow and that you would become increasingly dependent so that if you started using it, you’d have to stop it quickly or your body would develop this almost like chemical dependency on them. Turns out that’s not the case at all. None of the data has ever shown any convincing evidence that these medicines damage your body. But the problem is that it’s created this kind of culture of fear and even shame for having to use a laxative. A lot of my patients feel like it’s almost like a personal failure when they use a laxative. And I try to reframe that and just like constipation, it’s not just one condition.

(10:27)There’s a lot of different things that cause constipation, but it’s a disease like anything else. It can be. It’s not that everyone can fix their constipation with lifestyle changes the way you would think you should be able to do if you watch enough TikTok. It’s just not the case. It’s just like everybody who has high blood pressure is not going to cure their high blood pressure just by eating a low salt diet. People need medicine sometimes and that’s okay. And if it’ll help you live your best life, that’s what matters. So there’s no shame in taking a laxative. I’m not worried about dependency. You should always, of course, check with your doctor, come up with a plan. If you’re somebody who’s been at home without having seen a doctor and you’re taking multiple laxatives every day, absolutely have a conversation with someone to see what else could be missing, what else we could be optimizing that maybe doesn’t involve medicines, but don’t feel embarrassed or ashamed for having to need them too.

Jessie (11:19): I love that. I love that. But like you said, always talk to your healthcare provider for any of our listeners here just to check in because there may be something else we can do. All right. Myth number three here is constipation has a single definition. I think you kind of touched on that just now.

Dr. Trisha Pasricha (11:35): Yeah. Yeah. I mean, I think that that’s also a source of a lot of confusion and it’s constipation and it’s also diarrhea for that matter. Everyone who comes into my clinic, each person is going to have a different picture in their mind when they say, “I’m constipated.” You’ll have those people who are pooping once a day, but straining so hard they don’t think they’re constipated. And you’ll have people who are going every other day or every third day and it’s effortless, but it’s just kind of infrequent. They think they’re constipated, right? And actually, it may or may not be that at all depending on you. And the issue is that constipation is not caused by just one thing and there’s not just one physiological issue at play, right? The colon is a set of muscles, it’s a set of nerves, and then you have some control over some of those processes.

(12:25)You don’t have control consciously over some of the processes that go into having a good bowel movement. And for every person, there’s different elements of that coming into play. So when you come in to a doctor to get help, it’s helpful to just take a step back and describe, these are what my symptoms are like, this is what my frequency looks like. And let them decide on what are the right tests, what are the right sort of interventions you’re going to make to tailor that treatment to you. Because it’s very common that someone’s like, “Well, this worked for my friend. Why didn’t it work for me? ” Maybe it’s a supplement, maybe it’s a fiber, whatever it is. Maybe because your friends just had a totally different reason for being constipated than you, and that’s really common.

Jessie (13:03): Yeah, absolutely. I love that. All right. The next two myths we’re going to talk about is more so debunking certain things out there. Pounds of extra poop and toxin lurks in our guts at all times. Colon cleanses and other detox ritual helps.

Jessie (13:21): Yeah, Please tell us.

Dr. Trisha Pasricha (13:23): A lot of people think this. This is a really common pervasive myth that somehow when you feel really bloated or things are sluggish, that the problem is that there’s just poop hanging out inside of you and you need to cleanse all of that out. This often happens, I feel like people come to me and they’re like, “I had this really wild spring break week. I wasn’t doing the things I usually like to do at home. I was eating a lot of foods that I normally would need, drinking, whatever it is. ” Then they feel they need to detox when they come home. And the truth is that that’s just not how your body works. I mean, we know this because we go in and do emergency scopes all the time on people who are not fully prepped. We usually want to prep people, which means we clean it up, but sometimes we go in there, we see what it looks like.

(14:10)And yeah, things are dirty and things are moving along, but things are never frozen, solid, caked onto your colon. Your poop is always in a state of transit. And so this idea that you need to detox and cleanse that out, it’s not doing anything different for you than what was going to happen naturally. And you’re not going to suddenly shed 10 pounds. You’re going to lose a lot of water and you’re going to maybe lose weight that way, but that’s not necessarily the healthiest of moose, but you’re not necessarily losing a lot of weight long term because you’ve just gotten that poop out of there. Remember that the colon and actually all of your gut, it’s got this thick mucus lining. That mucous lining is keeping things from becoming concrete against the side of the walls. It simply won’t work that way. And the idea that we have such a detox culture out there because I think we all have seen these stories and they’re certainly worrisome about chemicals in our environment and forever chemicals and plastics and all of these things that we’re like, what are we putting into our bodies?

(15:05)What are we being exposed to? We should detox from that. The good news is that you have this built-in detoxifier called your liver. Everything that comes through your gut, if you remember the anatomy that we learned in high school, none of that immediately enters your bloodstream. It’s all entering this separate system, the circulation system that gets filtered first by your liver before it hits the rest of your bloodstream. That’s what the liver’s job is for, and it does a really good job of it.

Jessie (15:32): Yeah, I love that. And of course, shedding the mucus, right? A lot of the cancers and detoxes, they actually do that and it can be harmful for our gut

Dr. Trisha Pasricha (15:40): Microbiota. Yes. Exactly. Exactly.

Jessie (15:44): Yeah. Those are the risks people don’t talk about. Okay. The last myth here is for you IBS girlies that are listening or IBS warriors. Okay. If you struggle with your gut health, but all your tests are normal, the problem is in your head.

Dr. Trisha Pasricha (16:01): Yeah. That’s the one that everyone gets told, right? I think sometimes I hear … I would guess once a week, maybe a little more often depending, that patients will tell me, “You’re the first person who’s told me it’s not in my head.” And that’s because when you have IBS, you’ve been dealing with symptoms for so long often, and you will have had dozens of tests, dozen of doctors will look at you and be like, “But everything’s normal.” And eventually when everything looks normal, a lot of doctors will say, “Well, it must be stress. It must be anxiety. It must be your depression.” And you’ll start to feel like the problem is almost self-created, and at least that’s how you sometimes get made to feel. And one, that’s entirely wrong. That’s totally incorrect. The problem is not in your head. The problem is that the tests we do in clinic are not looking at the nervous system, that network of nerves that lives in our guts.

(16:56)And that’s often where much of the problem, not all of it, but much of the problem resides. And the problem with that is that the kinds of tests we do, like for example, a colonoscopy, we get these surface level biopsies where we might look at just like the kind of final surface layer of that network of nerves, but we’re not getting to the deeper layer where a lot of the issues are. It turns out if we did certain types of stains like we do in research settings, even on that surface layer, we would actually see lots of abnormalities, but they’re not typical kinds of stains that we do on these biopsies that we get of people. So it looks normal. And then people get told, “Okay, well, what you need is an antidepressant.” And what I spent a lot of time talking about with my patients and in this book are that here are all the different ways that we have proven that there are molecular and cellular changes happening in the gut, not in the brain, not in the spinal cord, but in the gut first.

(17:51)And then certainly those changes influence your, they travel through your spinal cord and they influence your brain. And then sometimes the brain and the symptoms that are caused there can then of course cause changes to your gut too. And in turn, you create this vicious cycle, but sometimes stopping that cycle means we have to intervene at the level of the gut. We may also, a lot of people will benefit from anti-anxiety medicines, antidepressants. And I start this on my patients all the time, but we can’t just look in one spot. We often, and I always say more often than not, need to look at the gut first.

Jessie (18:25): Oh, I love that. I love that. IBS patients, you’re feeling validated. And I think yesterday I had a dietician who has postinfectious IBS, came onto the podcast and shared her story. She went to four GIs herself to finally find somebody that would listen to her. So for those of you who are out there who may feel like you’ve been written off, that’s a word I hear a lot from my patients. Go find another provider, get a second opinion. It’s okay. Our feelings don’t get hurt, but finding the right match for you is really important.

Dr. Trisha Pasricha (19:03): I love that you say that. I actually think you’re right that a lot of patients think that they’re going to offend me if they get a second opinion and that should never be … I haven’t met any doctor who feels offended. In fact, sometimes I’m delighted when somebody gets another opinion because then that other person might’ve had an idea I didn’t even think of. And I’m like, oh my gosh, that’s such a good … I’m so glad you found something that worked. It’s actually, we kind of all know each other and we’re kind of part of this network. So it’s great if you do it. Don’t worry about offending people. Worry about yourself and your needs. That’s the most important thing.

Jessie (19:34): I love that. All right. Well, let’s move on to our second topic, the three piece of pooping. I love it so much because we don’t talk about proper pooping enough.

Dr. Trisha Pasricha (19:46): We don’t. So this is a framework that I use for anyone who’s coming in with bowel problems, which is a lot of people. And sometimes I liken having a bowel movement to try to get toothpaste out of a toothpaste tube. And this is where that 3P framework comes in. So 1P is propulsion. You have to squeeze that toothpaste tube. You have to create these contractions in your colon in order to generate a bowel movement, in order for that to move outwards. And that can sometimes be one reason why you may be constipated is your colon is not producing contractions on its own, or maybe there’s an issue with the kind of pressure you can generate when we do that bear down that valsalva maneuver to have a bowel movement. That’s 1P, the propulsion. The second P is pliability, and that’s how soft the toothpaste is, right?

(20:30)And a lot of the times we think, okay, well, maybe the problem is the stool is too hard. It comes out in these cracked, hard, tiny little pebbles. Maybe what we need to do is soften it up. And certainly no matter how hard you squeeze a rock solid 10-year-old toothpaste, it won’t come out unless you’ve softened it up. So that sometimes is also the problem. And I think a lot of what we do when we’re thinking about this at home and how to fix this is focusing on those first two Ps. And what we really neglect and don’t think about as much as we should is the third P, which is the pelvic floor. And that’s basically like trying to squeeze toothpaste out of the toothpaste tube, but never taking that cap off. And this is remarkably common. Pelvic floor dysfunction refers to the idea that our pelvic floor, so that’s the bottom part of our abdominal cavity has like more than 12 muscles that all have to coordinate together at that moment when you’re having a bowel movement.

(21:20)And sometimes they don’t. Sometimes over time, we train them to actually work against us. And so the muscles that are supposed to contract don’t generate enough pressure. And the ones that are supposed to relax paradoxically start to contract and close that door. And this is common, like more than you’d think, one out of three people who’ve been struggling with constipation, tried laxatives, nothing seems to be working. One out of three, the issue is the pelvic floor. And not enough people are getting assessed for that, treated for that. It is not just a women’s problem. It affects men. It’s not one of those things. When I talk about pelvic floor dysfunction, I think a lot of people are like, “Wait, I haven’t had kids yet. How can this be me? ” That’s a different kind of pelvic floor dysfunction. Okay. And it takes a different kind of physical therapist to treat it.

(22:06)But the good news is that it can be treated just with physical therapy and people do really well. It’s a special kind of physical therapy called biofeedback, but the studies have shown that it’s very effective. And there are other issues that go into the pelvic floor that we can talk about, but that’s the general framework that I think about when we’re trying to have a bowel movement and how to make it as effective and effortless as possible. Sometimes we focus just on one of those three and you really want to think about how we’re optimizing all three at once.

Jessie (22:34): Yeah, I love that. And for listeners listening, we actually had a podcast episode with Dr. Molly, who’s a pelvic floor therapist, and she walks through what the pelvic floor does and what an assessment look like. I think a lot of the fear is going in and these are very private parts of our body and getting an assessment, it can sound very scary. It is very scary sometimes for some people, especially if you’ve had a history of trauma, but hearing from a doctor who performs it, walks you through the process can help you prep for it. So if you want, listen to that episode. I don’t have the episode number on the top of my head, but it’s somewhere in there. Go look for it. And I love what you’re saying. It’s like all three Ps needs to be working properly. And what you’re saying too is the first P could be slow transit, right? It’s slow transit or transit issue .

Jessie (23:27): The second P is like your stool consistency can make it difficult to pass through. And the third P is the pelvic floor. And it can be one of the three. It can be all three working, maybe not working together and you got to tackle one thing at a time. And that’s something we see all the time in our clinic. Adding fluids and fiber, yes, that can help soften your stool, but if there’s something wrong with the pelvic floor, that’s not something you can do with just nutrition. You really need to get an assessment. Well, I love it. I love it talking about how to poop. Now, the third thing- Me too. The most important thing here is tell us about your research into the gut brain access and the gut brain interaction and maybe provide some solid tools at the end to help patients.

Dr. Trisha Pasricha (24:15): Yeah. Yeah. So I study my lab, I have a K23 grant from the NIH and I’m studying Parkinson’s disease. And that’s like a surprising thing sometimes to people because they’re like, “Why is a gastroenterologist studying Parkinson’s disease?” And as it turns out, there are a lot of neurological conditions. Parkinson’s is one of them that we’ve thought of as being in the brain in our heads, but actually they may well start in our guts. And this came about when I was maybe five or six years ago and I had just started out seeing patients on my own after finishing GI fellowship. And I started seeing several Parkinson’s patients who I noticed this odd pattern that they all had GI symptoms. And it turns out, yeah, about 80% of Parkinson’s patients suffer from GI symptoms. But the weirder part is that most of them told me I had GI symptoms before my Parkinson’s started.

(25:06)I would get this constipation that started years, maybe even decades before I got tremors. And it felt really odd. And it turns out though that in the literature, having constipation, having a slowing of your stomach and even IBS, these things can predict the development of Parkinson’s disease. Now, I want everyone to calm down because we all get constipated. We’re not all going to get Parkinson’s disease, but it is part of this prodromal set of symptoms that can predict it, especially if you have a family history or other kinds of things like disrupted sleep. And what we think is happening is that there’s some trigger in our environment that enters our guts. And there’s been a lot of discussion about what those triggers could be. Maybe it’s pesticides or chemicals in our environment. Maybe it’s an infection, maybe it’s something in the food that we eat.

(25:51)One thing my lab has studied a lot is ulcers, ulcers that we get in our stomachs and or other kinds of damage to the lining of our gut. Maybe those things are what starts you on that path. And we think that this protein, which is called alpha synuclein, which is misfolded and Parkinson’s disease actually starts first to misfold in your gut. And as it does so, it causes other such proteins to misfold and they propagate up through the vagus nerve, which is this big information super highway connecting the brain and the gut together. And it travels up there over a process that we think takes years before it ultimately reaches the brain. And then those proteins, those misfolded proteins can kill these neurons that produce dopamine in the brain. And that’s when you start to see tremors. That’s when you ultimately get a diagnosis of Parkinson’s.

(26:36)But it turns out that for at least some people, that process has been going on and brewing inside your body for a long time. So we are hoping that we can start to identify possible early signs of when these proteins start to misfold and changes occur in the gut years before they reach the brain. And then of course the biggest dream would be how to intervene and how to stop it from reaching the brain. Now, we’re far away from that, but that’s where the field is going and that’s what my lab is focused on.

Jessie (27:03): That’s fascinating. And we know there is a connection, right? But now you’re saying proteins are traveling upwards and then it can affect the brain eventually.

Dr. Trisha Pasricha (27:13): Yeah. What? Yeah. The vagus seems to be a big mediator of a lot of those connections. I mean, they’ve also, this was not my lab, but they’ve done these studies in the past where it turns out that people who have had surgeries that cut the vagus nerve, which was something they used to do in the 1980s and 1990s, more 1980s, those people are significantly less likely to get Parkinson’s later in life. And it’s probably because a lot of Parkinson’s patients are getting their Parkinson’s disease starting in the gut, and this is just ending that cycle. And of course, we don’t want to cut everybody’s vagus nerve. That would not be a good idea that’s not prophylactic, but it does kind of help support this hypothesis that this is what is what’s going on and gives us clues on where we should start to look.

Jessie (27:55): Okay. Well, that is crazy.

Dr. Trisha Pasricha (27:58): I know it’s really a cool field.

Jessie (28:01): Yeah. I think we’ve heard my studies about the vagus nerve. When you cut their vagus nerve, they don’t survive for as long when you drop a mice in the water. But I don’t think that’s done in human, but now hearing from you that studies or people where these surgeries were performed in the past, that just blows my mind.

Dr. Trisha Pasricha (28:22): Yeah. Yeah. The stuff you can learn just by looking back in time at the stuff we used to do to people, but we don’t anymore.

Jessie (28:28): Okay, good, good. Now, what are some helpful tools, right? Let’s maybe say three things from your book that you would recommend for people to do, to improve their gut function or maybe to avoid pain in their butt. I love that.

Dr. Trisha Pasricha (28:46): Yeah. Sometimes I think about, let’s just start somewhere really simple, which is thinking about, well, what are ways that modern life has made it more difficult to go to the bathroom? And if I was thinking about three things that we’ve done kind of to ourselves as a society, it would be one, the kinds of foods we’re eating. Ultra processed foods are 60% of our diet today. And it’s not just what goes into ultra processed foods like the added emulsifiers and other ingredients and chemicals. It’s more that the ultra processed foods prevent you from getting nutrients and fiber that would be in whole foods and other. They’re notoriously low on fiber. And so 95% of Americans don’t meet their fiber goals. Ultra processed foods are a big part of that problem. So if I could tell you guys to do just one thing from a diet standpoint, it would be to take a fiber supplement.

(29:37)I’m not even telling you, change your diet, stop eating the foods you love because that’s hard. That is what I want you to do eventually. But if you could just start in one place, it would be to take a fiber supplement. That’s the lowest hanging fruit there. The second thing that I think we’ve done to ourselves is we’ve developed these toilets that are basically this chair-like nine We need to reposition just like we’re sitting right now. And that’s not how we used to poop thousands of years ago. They did see these types of chairs back in the Roman Empire, but if you go even further back, and certainly in some parts of the world today, people are just squatting. Squatting was the most natural way to do it. It still is today. And I have a two-year-old and if we go to daycares and you see kids running around in diapers, they just pop the deepest squat of their lives when they’re pooping.

(30:27)They’re not sitting on chairs and doing it. Kids know intuitively that squatting is the easiest way to do it, but we have decided that that’s uncomfortable. It’s not as relaxing. We’re going to sit on a chair and do it. But what happens when we’re talking about the pelvic floor is there’s this muscle called the puber rectalis muscle that creates this sling around the colon and it chokes it closed. It’s almost like your body’s stepping on its own hose. That’s closed when we’re sitting down. And that’s a good thing because it kind of gives us a little extra tightening of that door so that when we’re sitting, we’re not feeling that pressure to poop. But when we are sitting on a bathroom on the toilet, we want that. We want the door to be open and we’re shutting it. The easiest thing you can do if you’re not going to squat, which I get it, nobody wants to squat anymore in 2026.

(31:09)All you have to do is raise your knees up above the level of your waist. And you can do that with a stool. You can do that with a set of books. You don’t have to buy anything fancy, like whatever box you just got from Amazon. You can stick that under there and that’ll get you up. And then the last thing for three things that I think we should change, the third one is don’t bring your smartphone into the bathroom. I know that one is really hard to hear. I’m guilty. We’re all guilty. The problem with smartphones, because we’ve been reading in the bathroom for a long time. Everyone reads. We used to though, we used to read newspapers. We used to read old, and not just newspapers, like old newspapers. We used to read old magazines. I had this comic book that we used to have.

(31:48)Those things weren’t like hijacking your brain the way TikTok does now, the way Instagram does that traps you in this endless scroll. We used to be able to just read, get a little sense of relaxation and move on and walk out the door. Now people are spending five, 10, 15 minutes unintentionally, not because they’re straining, but because they’re just sitting there distracted by their phones. And what we found in my lab happens is that the people who are spending more time doing that are the smartphone users and the smartphone users are the ones who are at higher risk of having hemorrhoids. We don’t want hemorrhoids. Hemorrhoids are not going to kill you, but anyone who has hemorrhoids, they don’t want them. We don’t want those. The easiest thing you can do is if you have to bring your cell phone in, and I empathize, just set a two TikTok limit.

(32:37)Say after two TikToks, I’m going to check in with myself and say, “Am I still doing what I came in here to do? ” And if you’re not, pull your pants up, go watch TikTok at your desk. You don’t have to keep doing it in that situation with your pants down.

Jessie (32:51): I want to go back to something you just said. So in the past, when we go in and read something, it has a relaxation effect.

Dr. Trisha Pasricha (32:58): Yeah.

Jessie (32:59): Social media does not have a relaxation.

Dr. Trisha Pasricha (33:03): I think you’re exactly right. Nobody feels … I mean, they’ve done these studies in other contexts. People almost always feel worse when they go on social media than when they started. Because we all eventually get caught by rage bait or we get caught in this doom scroll and it’ll happen to you. And you need to feel relaxed, a little distracted, and your sphincters need to relax and open up. That’s how you feel safe. I mean, if you don’t feel safe, it’s very hard to have a good evacuation. And also, you kind of have to be paying attention because you need to be generating a little bit of pressure to have that Valsalva maneuver. And the longer you’re sitting there doing nothing, upset by whatever you’re seeing on social media, if you do that every day or maybe even multiple times a day, over weeks, over years, the connective tissue holding up your hemorrhoids, we think, starts to weaken.

(33:53)And the pelvic floor, which doesn’t have any support because we’re on this open bowl, will cause those hemorrhoids to engorge and bulge, and eventually they become a problem.

Jessie (34:02): Yeah, absolutely. So people listening, put your phone away or listen to a podcast when you’re on the potty.

Dr. Trisha Pasricha (34:09): Yeah, nice relaxing. Yeah.

Jessie (34:13): Well, thank you so much for sharing all of these nuggets with me. And again, Dr. Trisha Prostriga’s new book is you’ve been pooping all wrong. And I’m telling you, you will learn something new here. And it’s a fascinating read. It’s short, it’s funny, it’s useful, especially for those of you who may be struggling with gut symptoms. You are not alone out there and we are here for you. Thank you, Dr. Pascha.

Dr. Trisha Pasricha (34:40): Thank you so much for having me. This was so much fun.

Jessie (34:44): Same, same. All right. Thank you everybody. Thank you for tuning into the IBS Nutrition Podcast. We hope today’s episode has brought you closer to understanding and managing IBS. Remember, you are not alone on this journey and finding freedom is possible. For more on IBS, make sure to follow us on your favorite podcast platforms and please leave us a five-star review. We would really appreciate that. You can access links mentioned in this episode in the show notes to learn more about your type of IBS and how to identify your own food or lifestyle triggers. Register for our free IBS Masterclass, Three Steps to IBS Relief for our proven, holistic three-steps approach to managing IBS once and for all. Head to IBSdietician.com/masterclasstoregister. Until next time, take good care of your guts and hears to your health and happiness.