Bite Back with Abbey Sharp - The POOP Conversation You KNOW You Need (Stinky Farts, Colon Cleanses, IBS + Food Intolerances) with Dr. Trisha Pasricha

Episode Date: March 24, 2026

Here’s a run down of what we discussed in today’s episode: Why Do We Always Have to Poop in Stores? (Breaking the Taboo) The Gut–Brain Axis: How Stress and Emotions Affect Digestion Can Your Gut Affect Your Brain? IBS, Mood & ADHD Connections IBS Isn’t “All in Your Head”: The Role of Mast Cells Why Your Poop Smells (and What It Means) Laxatives, Dependency & What’s Actually Safe Do You Need a Colon Cleanse or Detox? (Spoiler: No) Colonics, Coffee Enemas & Wellness Myths Debunked The 3 P’s of Poop: Pelvic Floor, Pressure & Stool Quality How to Improve Your Poop: Fiber, Hydration & Daily Habits Check in with today’s amazing guest: Dr. Trisha Pasricha Website: trishapasricha.com Instagram: instagram.com/trishapasrichamd Book: You’ve Been Pooping All Wrong Disclaimer: The content in this episode is for educational and entertainment purposes only and is never a substitute for medical advice. If you’re struggling with with your mental or physical health, please work one on one with a health care provider. If you have heard yourself in our discussion today, and are looking for support, contact the free NEDIC helpline at 1-866-NEDIC-20 or go to eatingdisorderhope.com. • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •✨ Reach Your Weight & Health Goals — Without Dieting! Pre-order The Hunger Crushing Combo Method, Abbey’s revolutionary additive approach to eating well. Learn how to boost satiety, stabilize blood sugars, reduce disease risk, and improve your relationship with food — all while getting the best nutrient bang for your caloric buck. With 400+ research citations, cheat sheets, evidence-based actionable tips, meal plans, and adaptable recipes, The Hunger Crushing Combo Method is the only nutrition bible you’ll ever need. 👉 Pre-order today! 🛒 Where to Purchase:AmazonBarnes & NobleAmazon KindleApple BooksGoogle PlayKoboApple Books (Audiobook)Audibleabbeyskitchen.com/hunger-crushing-combo• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •✉️ Subscribe to My Newsletters:Abbey’s Kitchen Newsletter 📘 Check out my FREE E-Books:Hunger Crushing Combo™ E-BookProtein 101 E-Book👋 Follow me!Instagram: @abbeyskitchenTikTok: @abbeyskitchenYouTube: @AbbeysKitchenBlog: abbeyskitchen.comBook: The Mindful Glow Cookbook • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 🎧 Don’t forget to subscribe on Apple Podcasts, Spotify, or wherever you listen — and leave us a review! It really helps support the show ❤️ 💬 If you liked this podcast, please like, follow, and leave a review — and let me know who you’d love to hear about next! ⭐ ⭐ ⭐⭐ ⭐ 

IBS was traditionally thought of as being all in our heads. Like this was like a, like you need to de-stress. Welcome to another episode, A Bite Back with Abby Sharp, where I dismantle diet culture rules, call out the charlatans spinning the pseudoscience, and help you achieve food freedom for good. If you think poop is just poop, well, think again. Today we are diving. Yes, I'm saying we're diving into the surprisingly fast. fascinating world of your bowels. From pelvic floor problems masquerading as constipation,

to what your poop smell is really trying to tell you, to the truth about laxatives, cleanses, and why so many of us are apparently pooping all wrong. I'm joined by the brilliant Dr. Trisha Pasha, a Harvard-trained gastroenterologist, researcher, and author of the brand new book you've been pooping all wrong. In this episode, we are unpacking the massive role of our pelvic floor in constipation, the brain gut access, and how we know that IBS is not just a mental problem, the biggest poop myths the wellness world refuses to let die, plus some more taboo topics like smells, laxatives, colonics, and cleanses.

I'll also end on some of my dietitian tips for helping you get that perfect soft snake out of the cage. So whether you are a chronic IBS struggler or suffer occasional disruptions from travel or schedule changes, buckle up, my friends. We are about to change the way you think about your bathroom routine forever. Let's get into it. Tricia, I am so excited. Thank you so much for joining me. Like, I am an IBS girlie. I was just so excited when I heard about this book and I read it front to back, no joke, it did not disappoint. So thank you. Thank you. And also, I'm so glad to talk to you and I'm so excited to be here. So thanks for the invite. Amazing. Okay, so first of all, we got to like, let's break the ice on this taboo topic

that should not be taboo. And I got to just ask, like, why does everyone have to poop when they go to Target? Great question. First of all, thanks for saying that out loud. We're not alone. you're not alone, whoever's going to you're listening to this. There are a lot of different reasons, right? Like for some people, it's the Target, some people it's the shopping mall. A lot of people, it's a bookstore. And, you know, and that's actually been like written about in the Japanese media, like a lot. This is like a phenomena that is worldwide. But there's something, I think, about a pattern that develops, you know? And so I think the thing to learn about our guts is that our guts can be trained and they can be trained into a routine. In fact, our colones love a routine. They're unlike

any other organ in our body, right? Like our heart is kind of doing the same thing throughout the 24 hours of the day. It slows down at night. The colon really has a strong circadian rhythm. And it just, it abides by these different rules. So if we train it to sort of feel like the bathroom and the target is a safe place, I'm comfortable, I'm in my happy spot right now, I'm browsing, some reading materials, so I'm activating my vagus nerve, you have to go to the bathroom. That pattern is going to start to repeat every time you go. And so it's like as bizarre as this sounds, we see, I see this all the time with my patients and with my girlfriends and, you know, any kind of friend that there's places in our lives that we just think of as like our safe

place and they're just like, it's where we go. And so that's why that bathroom is always crowded. I, okay, first of all, I'm Canadian and I have the IBSC. So I'm like, I need a Target. I need a target. I will go to the target every day when I'm having a bit of a digestive situation. I need to just live in a target. Apparently all this IBSC girlies need to be in the target. Okay. I've got so many questions. As if we needed another reason. Right. As if I need to spend more money basically on things I don't need. Okay, but I've got so many questions. I don't even know where to start. I'm very excited about this. Clearly, this is my jam. I'm so happy. Let's dive in. Oh, let's talk about poop. Okay. So, I mean, obviously for something that is so natural, like, we as a society have just, like, trained ourselves out of intuitively answering nature's call. And like, you know, like, we've got all these rules about, like, when we can poop and where and like, what if it smells and like, what if we miss our pooping window? Like, this is the shit I think about it all the time. Right? Like, oh, it's, it's rough. And so here on my channel, we definitely talk a lot about the brain gut access.

And, you know, this is this bidirectional communication system via the vagus nerve that links your thoughts and emotions and stress with how your gut operates. And so I'm curious, like, for folks that have sensitive tummies, like, we know how, like, stress can cause some of these IBS symptoms. Like, we get butterflies. We might get urgency, et cetera. Yes. But what about that opposite direction? Because we don't talk about that very often. how does our gut affect our brain?

Yes. Okay, so much to unpack here, and I'm so excited to talk about all of it. So I think a lot of people, just like you said, a lot of people really familiar with this idea that our brain impacts our gut. And I'm a neuro gastroenterologist, meaning I studied gastroenterology. I am a gastroenterologist, but then I did a subspecialty fellowship in neurogesteratron. Which is the study of the gut-brain connection. So this is, and I run a lab that studies this communication, so this is totally my, jam as well. And I think that way of thinking about the brain as influencing the gut is really

like the traditional way of thinking about every organ in our body. The brain is dictating what the rest of our body is doing all through the vagus nerve. So the vagus nerve is this long nerve from it who's not familiar. It's the largest cranial nerve in our body. It connects the brain, not just to the gut, but to every major organ. Within, and people have known about how the brain influences the gut for several decades. Like there were these classic experiments in the 1950s, which I often cite, that were done at Cornell. They were actually done on Cornell medical students, but where they found that acute stress,

so they would stress these medical students, this is going to sound really unethical, and it was, but they would stress these medical students by making them believe that the researchers were seeing like a colorectal cancer. And they would watch as they were doing this kind of early equivalent of a kind of colonoscopy, how their colon started to contract and squeeze

as these students started to believe that what the researchers were seeing was cancer. And that was some of our earlier insights into how in real time our thoughts, our beliefs, our fears, our anxiety can manifest in these like very real ways. And then, of course, the researchers did, just to be clear, did tell the students, like, just kidding. Just kidding. It wasn't. It's not cancer. We just were faking. I know. Good one. I know. Like, and today we're like, what? How this? Oh, for sure. This would never have gone through. I mean. Yeah, yeah. But it was like a good example of how we learned. But that's the old. way of thinking about it. And I think what we have now found in like just decades more of research is that 90% of the communication on that vagus nerve highway is from the gut up to the brain,

not the other way around. And so we're seeing so much more within the last several years and even decades about research that's showing us how everything from our outside environment that makes its way into our stomachs and to our guts and to our small valves and colones, that all gets influenced by our microbiome, which are these trillions of bacteria that live inside our guts, and then the products that they make, the bacteria are breaking down what we've put into our bodies and what they produce and how different kinds of bacteria produce different metabolites. And those not just influence our gut, but they get absorbed into our blood changes, so they really influence our brains and the rest of our health.

So we're starting to learn about all of these different things. And it started out as a smaller field of neurogestontrology, like in the 1990. it's now blossomed into a much bigger, more exciting factor because, you know, I think if we look at things historically, and I know you're, you've been suffering with IBS, so you'll, you'll, I'm sure this will resonate. I see this in my own patients. IBS was traditionally thought of as being all in our heads. Like this was like a, you need to de-stress. Yep. You know, and like what you need is maybe you need cognitive behavioral therapy. Maybe you need like something for depression, some treatment for your anxiety. And sure, people with IBS do have more depression,

objectively true. Who wouldn't? It's a chronic disease. Like, right? But it's the root cause, the problem of IBS we're discovering, like many of these disorders, is in the stomach. It's in the gut. It's in the colon. It's not in the brain. But there is this feedback loop. And then once something, you know, wherever that cycle starts, whether it's the brain or the stomach, once it starts, it becomes a cycle. And sometimes cutting it off at the level of the brain makes sense. Sometimes cutting it off at this at the level of the gut is what we really need to do and what we'd overlook. I think this is so interesting because you're right. I just I remember like maybe like six months ago I had a colonoscopy and just because again like my IBS symptoms I'm like oh there's

must be something going on like what like let's see and of course guess what they wrote on my report symptoms from stress consider stress relief. That was it. That's what I got. I was like very helpful. Very helpful. Of course. Great. Yeah. And, and you know, that's the, that's, honestly, this is the, like, frustrating thing that got me into this field. Because, one, I mean, there's so much culturally tied to this, but, like, IBS disproportionately affects women. It affects men, but women are almost twice as likely to get IBS than men. And so there's just been this, like, longstanding tradition in a lot of areas of medicine to take these symptoms that we can't immediately understand. we didn't understand them for a long time and say, okay, if we don't know what it is,

it's got to be stressed. It's got to be in her head. And I think the tragedy is that even today, there are a lot of physicians out there who, and everyone who hasn't caught up with the literature and are still saying things like that. So I'm sorry that you heard that. But, you know, I think what I find exciting about the field, like that's what got me into it and said, like, we've got to change this. I'm not the only one.

A lot of people have done some incredibly good research here in this field, which is like changed what I thought about IBS2. But I think we're now finding that there is so much that can happen in the gut that we will never see on a colonoscopy. Like a colonoscopy, we're getting the, you take a look on just the surface level, right? Like imagine if we think that you have a problem inside your heart. And all we're doing is like looking at your chest. We're like saying, okay, well, what does it look like on the skin? That's kind of what we're doing with a colonoscopy. And we're saying like, yeah, this looks normal. Looks fine. And maybe we get some biopsies. of the skin above your heart.

But like, we're never taking a look with an EKG, and that's exactly, you know, what we've been doing in IBS for so long is we're like scratching the surface with these biopsies. When what's happening in IBS, often is at the level of what we call the enteric nervous system. The interic nervous system is this network of nerves that runs deep throughout the entirety of your gut.

It lives in the muscle layer. That muscle layer you're never going to see in a colonoscopy because, to be frank, if we got all the way deep we'd be perforating you would be causing a big hole in your gut you don't want that to happen but it is as complex as what we the central nervous system which is your brain and those two things are what's connected by the vagus nerve you have to do really specialized tests to be able to see that we just don't do that in clinical practice we do that all the time in research so we know that these changes are real that they're there and they've been well quantified well studied but for the average person

walking in with ibs they're just not going to get those kinds of tests and then the average you know doctor might say well okay the tests are normal right this is just you know this is in your head this is stress yeah yeah you know from reading your book one of the things that i did not know anything about that i thought was very interesting was the potential role of like massed mass cell activation that can actually be seen by via scope in folks with ibs and food sensitivities when like no other physical markers are present um and again like this is very validating to those of us with ibs who have again be being told it's in our head um can you kind of like talk a little bit about that like what and how could we use this clue of like mass cell involvement in ibs to perhaps cure or

reduce symptoms yes okay so let's talk about what ibs is for just a second and what all of these symptoms are so you know ibs is at the way it's currently defined clinically is somebody who has some form of abdominal pain that's linked to having a bowel movement And it has to be going on for several months. That's really broad. That will encompass a lot of different kinds of people. And the truth is that we all agree, researchers, clinicians, that IBS is a very broad term that probably encompasses a lot of different kinds of pathologies.

And as, as you pointed out, some people have IBS that manifests as more frequent stools, or diarrhea. Some people have IBS that manifest more as constipation. Both of these things are linked by stress. And we can talk about the different mechanisms, but they manifest completely opposite ends of the spectrum. And then there's people who have like IBSM, which is IBS mix. And like these terms, I think, like, don't actually really help anybody because they're not talking about the pathophysiology of what's going on. But that's just how they've been classified.

But there's a lot of people who have, and a lot of people with IBS have food sensitivities. They're not necessarily food allergies. Like if you did tests of their blood, those blood tests would be normal. It's not like an allergy that an allergist would treat you for. And they're not like celiac disease, which is this autoimmune condition where people have a re-efficient. to gluten. But nonetheless, people with IBS and other people who don't have IBS have gluten intolerance all the time. So there's just a lot of different kinds of syndromes going on. Now, as I mentioned before, we used to not be able to get any kind of meaningful information from

just a standard colonoscopy or an upper endoscopy. That's the upper endoscopy is the like sister test of a colonoscopy where we look through the stomach and look at your small bowel. And a couple of years ago, a group of researchers in Belgium said, you know what? Like, maybe the reason we're never getting the answers during these endoscopy procedures is because we are doing them at the wrong time. And if you think about if anyone who's gotten a klonoscopy before, you have to fast since at least midnight that night before and you're taking the prep like later on. And that's like, you know, a whole other conversation.

Yeah. Yeah. I know you just got through this. And, you know, and the prep is, you know, there we have strategy. around that. But at any rate, you're not eating at the time. And there's a good reason why. And that's because when you eat, we don't want food in your stomach when you're under sedation to accidentally come back up and get into your lungs. Like, that's very dangerous. So there's a good reason why we did it that way. But if our goal is to understand why people have symptoms when they eat is the wrong

way to do the test. So researchers did this study that was actually ultimately published in nature. It was like, this was one of the studies that blew my mind and made me really get excited about about research in this field. But what they did was say, okay, you know what we're going to do in this very controlled experimental environment? We're going to take people who have IBS. And we are going to, through the scope, just spray this slurry of classic trigger foods, like dairy-containing products, like gluten-containing products, like seafood, et cetera. And we're just going to like gently spray a little bit onto that surface of the gut that we're seeing. Just see what happens. We're going to watch it in real time. And to their surprise, to everyone's surprise, to everyone's

who read this paper, these are people who they tested their blood for food allergies, who all their tests were otherwise normal. When they sprayed these certain trigger foods, they watched that surface of the of the gut erupt in these kind of like wheels and red flares that you might see as if you're having an allergic reaction on the skin, but inside their guts. And you would never have seen this if you hadn't been looking at the time they were eating. And it told those researchers that, wow, every time this person is eating the foods that they're saying is triggering them, it is causing this like really real reaction, which if we were to see that happening to someone at the dinner table, we'd panic. We'd say, oh my God, let's go to the emergency room.

For sure. This is horrible. But somebody who's just sitting there looks fine and is saying, oh, I feel awful. Eventually, when all the tests are negative, everyone's like, okay, well, you know, like, you're being difficult. Like, this is like, I don't know. why you're like deliminaled all this stuff, but actually there was a very real pathology. And so one of the things that they ultimately did was they looked at microscopically, what are these foods doing? Some of this was being mediated for some patients by mast cells. So mass cells are these inflammatory cells that are often seen in an allergic reaction

in other parts of your body in the stomach and in the small bowel in these patients that they were looking at, they were just staying right there in the gut. so you wouldn't catch them. Like if you got a blood test, they stay there, but they released all of these inflammatory compounds and molecules when these foods came in contact with the surface of their gut. And those mast cells triggered the nerve cells. So we have nerve cells throughout our whole gut.

Those cause pain. So not only is their inflammation, but it's incredibly painful. People have abdominal discomfort and frank pain from eating these foods. And they were able to find in subsequent studies that if they were to give these patients medications that inhibited the mast cells, stop them from erupting and causing a lot of inflammation, they could mitigate their pain. That's huge. Like, we don't, that is one of those treatments that I think almost none of my patients who come

in my clinic for IBS have ever been told is a possibility, right? Like, yeah, it's just not something that people usually think about because, again, their tests are normal. Like, who is thinking that they have, like, mast cell mediated problems, but they do in some subset of patients. Now, again, the problem is that I'm not doing that test on a lot of my patients of IBS who come in. And so, but what I am doing is thinking about this as a possibility, and I'm trying and seeing what may or may not work. And so I think I'll say that, like, the gap here is that we do need to, and the field is working really hard to do this. We do need to come up with a way to do these kinds of tests.

I don't think every single person with IBS has mass cell media disease, but clearly a lot of people do. We need to figure out how to identify them and treat them and not make it a little bit of guesswork. But until we can, at very least, it's important to find a doctor who is at least thinking about all these other possibilities and not just saying, why don't we get you on an SSRI or an SNRI for pain, which you may well need and that would be great. But we can't stop right there. Right. Oh, that is fascinating. Oh, my gosh. I love this science. I love it, baby. Okay, okay. I want to do like a quick and dirty speed round on some

like taboo poop subtopics. My favorite topic. Thank you. Good. Of course. Okay, you're ready? Ready. Let's do it. Can we make our shit not stick? There are a couple of different ways. So one, okay, the reason that our gas and our poop smells is being driven by sulfur. Okay, so that's present in and or created by a lot of the foods that we eat. Certain foods are known to trigger that reaction a little bit more strongly. So if you feel like really strongly, first of all, I don't think we should be so worried about poop sticking. I agree. I just want to say like culturally, this is what it is, you know, and there's no one among us, no one who is immune, okay? Like, who has like the world's most beautiful smell. We're all doing the same thing. We're all doing the same

thing and we shall be allowed to eat what makes us happy. For sure. And I do think, like, I tell patients who have a lot of anxiety about pooping in public restaurants, like they're at work all day, they have no choice or they're traveling, and this is a lot. Like, I say just carry around a little handheld spray. Like, they sell these, like, little poopery. Like, you can bring, that that will make you feel better.

I don't think we owe that courtesy necessarily to the world, but, like, fine. Like, if that helps you do that, if you have, like, a high stakes, like, outing, conference, taught date, and you're like, listen, I'm with you culturally. I, like, but I really don't want to stink up the place at my boyfriend's house

that I've just started dating. Then I would say take some peptobismol before that event, okay? Now, peptobismol, the bismuth, so peptobismol is bismuth subsalcillate. The bismuth neutralizes 99% of those sulfur-containing odors in our poop. Okay, so we think of peptobismol

and bismat subslidylate. It is like, yeah. Digestion. Up that stomach, diarrhea. Oh my, oh my God. That just came out of me. It just came out. Yeah.

Yeah, like it triggered something real deep, right? Yes. So that's what we think of it for. And this is not like the main reason I think people buy it, but it is very effective for the smell. So like, you know, I was just telling some some of my patients like around the holidays or whatever, you know, the event is, take a little bit beforehand. And it will help you. Like, if you have to go to the back. Rathoram as well you should. You should feel comfortable doing that, like, anywhere you need to go and

responding to that call of nature or if you have to pass some gas, like this will help you for that. But other, if not, you could always carry your poopery with you and any other neutralizing spray. I love that. And FYI, just so people know, like people, some people who feel like they get these like notoriously smelly furs, there are like a lot of supplements that are very popular that can cause more smelly farts like collagen, creatine, BCAAs, way protein, all of those like inulin, chicory root fiber, you know, bars and things like that. Very popular. And if you're like wondering like, hey, I'm eating quote unquote healthier. Why am I smell? Like, why am I'm so gassy and farty and it stinks? Maybe one of those things. So maybe the Peptobismol will help with that too. I love that.

I love that hack. It'll help. But I will tell you, just so nobody is surprised, Peptimismo also has this other side effect where it can turn your poop black. Okay, so don't let that shock you. Don't be like, oh my God, what's going on? Because the other thing that turns poop black is blood. Oh, that's right. Yeah. Well, iron from blood. Like if it's from, if you're bleeding in your stomach, it makes sense with your acid, it turns black. Iron supplements do it too. So if you see that turn normally, like if you see black poop and you're not taking anything that should do it, you got to call your doctor. You got to maybe go to the emergency room, especially if you're feeling like you're in pain, dizzy late. Go to the emergency.

the serum. But if you start taking peptobysmal, you see a black poop, just know that that can happen. Okay, good, good hot tip. I love that. Yes. Okay, laxatives. Like, I mean, we usually, you know, see a lot of people say, like, we should try to avoid, like, more stimulant laxatives, like sena, because they affect muscle contraction. If we want to use a laxative, go for more osmotic laxatives, like meg citrate or whatever. But if we are needing to rely on something like, you Sena or Dulclax or whatever, like what is the risk of our body becoming dependent on them if we use them regularly? One of the most common questions that I get.

And so let's, let me just talk about laxid is in general, right? So there's different ways that you can try to make having a bowel movement easier. The osmotic laxid is, which are like Myralax or Lactylose, what those are trying to do is bringing this substance like Miralax into your stool and that draws water in. from the rest of your body. It draws it into your colon, and it makes it nice and fluffy and soft so it can pass easily. And for some people, that's enough. But there are, everybody's different. And so there are people where the problem is really not how soft or fluffy the poop is. Like that could be sufficient, but it's just that the colon's not contracting. And that's more,

that problem is often more a problem with the enteric nervous system with their nerves. And so in some cases, people, a stimulant laxative is very helpful because that's really helping augment those contractions over. With everybody who needs a little bit of help, we try. Usually we recommend saying, let's try adding fiber. Let's change your diet. Let's try exercising because exercise also stimulates those contractions. So we try those other things, but I have no problem telling people.

If you need a medicine, you need something like a stimulant for the long term, like that's what you need, right? Like that's, I don't tell people with, you know, insulin-dependent diabetes, you know, eventually we want to get you off your insulin. Right. That's just what you need. Like, same with blood pressure. We congratulate people for being consistent with the blood pressure meds,

but we all have this like fear and a little bit of embarrassment and stigma about needing a laxative. When our colon has diseases and conditions just like every other organ in our body, and so, like, I think we should eliminate that sense of shame. But with that sense of shame is also what you said, is this fear that we've generated, I think we did this as doctors, that maybe you can become dependent on a laxative. So let me explain that. And specifically, those stimulant laxatives like Senna, which, you know, I like Sena because it is very powerful and it can come in like T-form,

which you can kind of titrate and people like that a lot. But there have actually never been any studies that have convincingly shown that stimulant laxatives damage your body in any way or that you develop a dependence, like a chemical neurological dependence on them. That's totally not true. And also what's not true is that you don't develop damage to your nerves such that when you stop them. You're actually in like a bigger hole than when you started. That's not been shown. I think the reason this whole myth started was because some of the earlier clinical trials were for a shorter

period of time, like two to three months and they just didn't study them long term. At the time that the trials were done, we now have decades of data of people using these who do great with them, right? Like it's true when you start them, you might be starting them because you have a condition that's not going to go away and you might just need them for life. But I will also tell you in it, and you may have experienced this yourself, everybody's bowels respond so differently over the course of weeks, over the course of months, to different changes in your lifestyle, some of which you are aware that you've made. You might say, like, I'm traveling right now. I know things are really off. You might not even know sometimes that, you know, how much your

stress is affecting your body or how much a small change in like an additive you're putting into your coffee is changing your stool. That I often tell people when I, counsel them on starting laxatives, like don't be surprised if you don't need this anymore in a couple of weeks to months. Like you, you, you, I know you have constipation, but this doesn't have to be for life. And you might not even know why things have changed, but something will have changed in your life. And that's okay. And you, we've got to just kind of keep going with the flow and titrating as things move along. Yeah, that's great. That's great. Okay, I got another one because there's this pervasive narrative that we have pounds and pounds

of extra poop and toxins in our gut just sitting around and we need like a colon cleanse or a detox to like fix this problem. What's what are your thoughts? You know part of me like almost wishes it were true. Like there are so many people I think who like want it to be the case that if they were just to detox, just to cleanse or like all their problems would be solved. And yeah, maybe they'll shed 20 pounds. Like who knows how much poop is just caked along the sides of the walls. This is the kind of stuff I hear. It's not true. And the way I know it's not true. is because I look inside people's colones every day. And it's not there.

And when we're doing CT scans, we're doing colonoscopies, that's not there. Now, it's certainly true if you have, you know, a condition where you have a lot of constipation, you will have more poop in your body at any one time. But it's not like sort of like lining the walls and possibly get out. The inside of your colon is so slippery. It's got like this mucus layer all over it that nothing is sticking to it the way I think people picture. And also, if you're having a bowel movement every day, every other day, or more often, as might be the case, if you're having a high fiber diet, which I highly encourage, then you're going to be doing just fine. And this idea that something is in our bodies, it really dates back, that's like putrefying was the word that was used like in the 1910s.

it comes from this idea that like when we eat things like meat or other kinds of foods that like when sitting out in room temperature go bad it's like well why it should it's been in my body for a day like shouldn't it go bad too no it's because when that food hits your body it is immediately immersed in this highly acidic environment in your stomach that breaks it down and then it moves on to your small bowel where it's further digested into the tiniest tiniest portions that get absorbed by your body. So it's no longer in any way molecularly resembling that thing that's sitting out on your table. So you don't need to detox. You don't need to do colonic cleanses, which always make me a little nervous. The overall risk of a cleanse, the thing

that worries me most is like someone would cause a little hole or a tear in their gut when they're putting things up there that they shouldn't. That risk is really low, but it's real enough that I think like, why would you do that? And why would you introduce things into your colon that don't belong? that could potentially throw off your microbiome. I don't love this idea at all. But I also think you don't need to do that because, you know what, we have a liver that is detoxifying everything that comes through our guts for us. And we have to treat our liver with respect.

Don't get me wrong. Like, we shouldn't pound it with like five alcoholic drinks a day. That's really hard on the liver. And anything else that, you know, like a lot of ultra-processed foods, these things do stress the liver out. But you're not going to undo that damage by doing a juice cleanse for three days. Like you will undo that damage by changing your life. lifestyle for the long term and changing a pattern of how you eat and things. So yes, to everybody

who's like thinking like, let me just lose 20 pounds by trying to do this decox, that won't happen. It shouldn't happen. You're actually just going to lose a ton of water because you might give yourself a lot of diarrhea and then and then it'll come back. Yeah. And I mean, the irony of the juice cleanse for gut health is that these juices contain no fiber, which is actually what we want. Thank you. When it comes to improving her gut health and regular bowel movements. I think it's so asinine and like, Mine blowing. Oh, thank you for saying that, yes. And you kind of, like, touched on this, like, with these cleanses, but, like, up the other end,

I guess, is the colonics. Like, should we be, like, flushing our bowels with coffee or just, like, warm water, for God's sakes? Like, how dangerous is this? Well, like, so I have patients on every end of the spectrum of disease. And so I do have patients who have very serious colonic motility conditions who use enemas often. And they're doing that for a medical reason, and they're doing it in a controlled environment. We know how to treat them and we help.

But the average person who doesn't have those specific conditions shouldn't be putting things up there that don't belong, especially like anything that can cause trauma. That makes me worried. And it makes me worried, like I said, because it could introduce a chemical in there that we don't want. It could also kind of disrupt the flora, the microbiome in there, and we don't want that. And there's been absolutely zero studies, okay, of these coffee enemas or anything else, that they're going to help with any of the things that people come to me for just the wildest ideas about what they'll do for their bodies, but they don't do any of those things. The only thing an enema can do that has been shown is that it can help, like, break up stool in there

if you have, like, a really serious condition. But that applies to so few people that I really don't want the average person to think that this is a good idea because on TikTok, someone told them that it like really changed their life. Yeah, yeah. And I mean, the reality is like most people are getting these kind of colonics or like colon irrigation treatments at like sketchy meddy spas by like, who knows? These are not medically supervised. Like that's also my concern with a lot of these these kind of treatments. But okay, I want to finish off with a very quick discussion on, you know, the pelvic floor piece. Because in the book you talk about like the three piece of a good poop propulsion which is the pressure in our bodies to

push the stool out pliability which comes down to like the softness of the stool which i'll talk about at the end of the show myself and then pelvic floor which i feel like no one is talking about in the context of ibs totally so can you like talk a little bit about like why is the pelvic floor and like how is that involved in like our ability to have a good bowel movement for especially for folks who like are struggling with that IBS piece. Yes. I am totally in agreement with you that the pelvic floor is on nobody's radar. When we hear pelvic floor, everyone thinks, like, oh, we're talking about, like, traumatic childbirth situations and, like, someone's like, oh, yeah, I got pelvic floor PT.

We think that that's, like, referring to just women who are getting PT for, like, urinary incontinence or other kinds of issues related to, like, some traumatic childhood situation. it is an incredibly common and underappreciated problem for constipation, like completely separate from anything related to what's going on in the front. And what we think is happening, and the problem is that it can look, when you have what's called pelvic floor dysfunction, it can look very similar to IBS, to just chronic constipation. You yourself might not know, your doctor might not know,

just hearing your story, whether the issue is an issue with the colon, not pushing moving things along, or the pelvic floor, not relaxing and contracting appropriately. So the pelvic floor is several different muscles that make up the very end of the gut, both the gut, because the gut at the very end has these two sphincters, the internal and external anal sphincter, those are considered part of the pelvic floor, and yes, you have two sphincters, they're like wrapped around each other. And then all these muscles that kind of support the end of the colon called the rectum and just the bottom part of the area. And paradoxically, what we need to happen with those sphincters is we need them, they usually should be nice and contracted at rest. Right. Otherwise, we'd all have a problem all day long.

But when we're going to the bathroom, we're trying to poop, we paradoxically need them to relax and open up. but while we need them to do that, we are bearing down and straining. And if you think about that, like, I'm doing this right now. My hands are clenched. I'm clenching. But I want those finctures to relax and open up. And it's like, it feels like this should be like pooping should be the most intuitive thing in the world. Everybody does it.

And yet a lot of us are not doing it wrong. And we eventually, the more we strain, maybe we start straining more because of another problem, because of a lack of fiber, because we have slow motility for some other reason. start to strain more, the more we strain, the more we train without really knowing it subconsciously, those sphincters to tighten up, such that even when we remove the thing that was the problem in the first place, maybe we go on a higher fiber diet, we started eating like the Mediterranean lifestyle and suddenly that problem's gone away. The sphincters have changed. We've trained them wrong, right? And that is so common. People say, like, I went, like, in

college, my college years is when this all started. And it's because people, that's like a time when people really change their diets, changed their lifestyle. And then that lingers. And so it could be that now you're in your 30s, 40s, and you're struggling. And it's because of just this change that has happened slowly but surely over the years, your muscle would change. The good news about this is that, one, we can easily test for it. It's done at specialized GI centers, but every kind of major city will have people who test this.

But it's a simple test that basically just looks like, are the muscles in your pelvic floor are relaxing at the right time? and are they contracting appropriately at the right time to give you that push? And if you have pelvic floor dysfunction, 80 to 90% of people will get better just with PT, just with physical therapy. Like, just get better after two to three months of this. Like, we're not talking about a lifelong medication, we're just talking about retraining. And it's a special kind of physical therapy called biofeedback,

but it is like just an incredibly helpful thing that if more people knew about it, a lot more people would get help easily. because I sometimes liking the pelvic floor to being like a tube of toothpaste, right? And so we're going to hit you with all these laxatives. That's what you're going to be doing at home and what your doctor will tell you that are trying to squeeze toothpaste out of the tube. So they'll make the squeeze stronger. They'll make the toothpaste softer. But if we never take that cap off, then nothing's going to ever come out. And sometimes when I send a patient to pelvic floor physical therapy with this biofeedback therapy,

it is like suddenly that cap gets taken off. And they like all these laxatives they're taking. They're like, whoa, we don't, we actually never needed this. in the first place or like we have like overshot and you can come back but until you do they're like i've tried so many laxate i've tried everything on the books the prescription stuff the over-the-counter stuff nothing is working if that sounds like you you should really think about public and that's actually what the got the american gastrithological the american college of gastrology have these guidelines that say if somebody with constipation has failed one or more of these laxid is you have to think about pelvic flores especially you have to look for it and test it i'm so grateful that you

brought this up and actually in reading the book i have to tell you i was like inspired to make an appointment i had an assessment yesterday good for you it's weird guys it's weird like it's weird there someone's putting their fingers up your ass and pressing around a little in there um but uh i think that it you're right like this is not being talked about no doctors ever told me to consider this. Yes. And so yeah, I think that this is really the way forward for a lot of people who have tried everything else to really just kind of like relearn that piece. So I'm grateful for reading your book and for you spreading these words because unfortunately while this topic remains taboo, like it shouldn't be because we're all going through it and just everybody

knows how good it feels to have a good poop. So like, yeah. I really, like, we all really want this. Whether we want to talk about it or not, we want this. We want this, guys. So, this is fantastic. Definitely everyone listening, pre-order Tricia's book, you've been pooping all wrong. I read it. I loved it. And so I'm going to also, of course, be leaving lots of links to where everyone can find your content because it is fantastic. So I love it. We'll all be taking a step towards pooforia, as you call it. I think this is great. Thank you, Abby. Thank you for having me on. Thank you. Okay, guys, I have gotten so much out of today's conversation and even more out of Trish's book. Just putting it out there, it is a winner. Now, as we close up, I really want to lend my experience and expertise to the second P of Trish's three P's of pooping,

aka the pliability. As this is where nutrition and lifestyle, comes into play. So here's a really quick and dirty of what I as a dietitian wants you to focus on if you are aiming for perfect soft sausage like stools every time. Number one, dial in your fiber, but don't go too nuts. We want to aim for around 25 to 38 grams for women and men respectively. Ideally from a combination of soluble fiber, which makes our stool soft and smooth, so things like oats, chia, flax, cillium, apples, beans, and barley, an insoluble fiber, which adds bulk, and speeds things up from things like veggies, whole grains, and the skins of other plants.

In Trish's book, she recommends adding a cillium fiber supplement, which is really the gold standard, but if you find that it causes some bloating, I actually much prefer partially hydrolyzed guar gum, which is another low Fodmap soluble fiber that dissolves clear, and is a lot easier for folks prone to gas and bloating. Number two, pay attention to hydration. If your stool looks like hard pebbles, you need to up your water with small sips throughout the day. If your stool is really super duper loose or watery, it's time to up the fiber and probably

to limit the alcohol and caffeine. Number three, eat consistently and eat enough calories. Skipping meals, eating erratically and under-eating, can significantly disrupt motility because your body is not getting that gastrocholic reflex that tells you that it's time to poop. And then over time with consistent under-eating, you will eventually see your GI muscles atrophy, which slows down your motility. So make sure you're consistently eating at least three meals a day at regular times with a new. enough calories total to fuel your body, while also adding in a source of fluid, fiber, protein, and some healthy fats, aka My Hunger Cushing combo. Number five, practice a relaxing morning routine, which might mean getting up a few minutes

before your family so that you can have a quiet cup of coffee, tea, or water, go for a little quick walk, or do some gentle stretching, or perhaps engage in other acts of quiet, peaceful self-care. A relaxed mind will mean a relaxed vowel. But on that note, happy pooping, my friends. I hope that people can feel that this is a safe place to learn about just like a traditionally taboo topic that really should not be taboo at all because say it with me folks, everybody poops. And a big thank you again to Dr. Trisha for teaching us how to reclaim our inherent pooping wisdom. I will be leaving a link in the show notes for where you can find her new book,

You've Been Pooping All Wrong. Signing off with Science and Sass. I'm Abby Sharp. Thanks for listening.