1 00:00:11,759 --> 00:00:16,199 Speaker 1: Hello everyone, and welcome to Talk Nerdy. Today's Monday, May fourth, 2 00:00:16,320 --> 00:00:18,480 twenty twenty six, and I'm the host of the show, 3 00:00:18,640 --> 00:00:21,960 Doctor Kara Santa Maria, And as always, before we dive 4 00:00:22,000 --> 00:00:24,039 into this week's episode, I want to thank those of 5 00:00:24,079 --> 00:00:28,719 you who make Talk Nerdy possible. We use Patreon that's 6 00:00:28,800 --> 00:00:32,439 p A t R e o n dot com slash 7 00:00:32,479 --> 00:00:34,960 talk Nerdy if you want to learn more. We use 8 00:00:35,000 --> 00:00:37,799 that as the platform to help fund the show, because 9 00:00:37,799 --> 00:00:39,920 I want to make sure that this continues to be 10 00:00:40,000 --> 00:00:43,679 free for anybody to download. If you are not in 11 00:00:43,719 --> 00:00:46,640 a position to support the show, or you just don't wanna, 12 00:00:46,840 --> 00:00:48,719 I want to make sure that you have access. 13 00:00:49,039 --> 00:00:50,119 Speaker 2: But for those of you who. 14 00:00:50,079 --> 00:00:54,039 Speaker 1: Are in a position and who who are very you know, 15 00:00:54,560 --> 00:01:00,600 selflessly and kindly, you know, patrons of the art, I'm 16 00:01:00,719 --> 00:01:02,679 just one of the arts, the sciences, the arts and 17 00:01:02,799 --> 00:01:05,719 the sciences. I am just, you know, beyond grateful for 18 00:01:05,799 --> 00:01:10,040 your continued episodic support of the show. And as a 19 00:01:10,040 --> 00:01:12,640 special thank you, I want to shout out the top 20 00:01:12,680 --> 00:01:16,599 patrons this week. They include Chuck Blell, David J. E. Smith, 21 00:01:16,879 --> 00:01:22,319 Daniel Lang, Mary Neva, Will Defraye, David Compton, Brian Holden Gabo, 22 00:01:22,400 --> 00:01:27,799 jay Ulrica, Hagman, Pasqually, Jelati, Rika Maharaj, and Joe Wilkinson. 23 00:01:29,000 --> 00:01:32,319 All Right, this week I had the opportunity to speak 24 00:01:32,400 --> 00:01:37,760 with doctor Tricia pas Rica. She's an assistant professor of 25 00:01:37,840 --> 00:01:41,120 medicine at Harvard Medical School and she's the Ask a 26 00:01:41,200 --> 00:01:45,719 Doctor columnist for The Washington Post and currently she serves 27 00:01:45,799 --> 00:01:49,599 as director of the Institute for Gut Brain Research at 28 00:01:49,719 --> 00:01:53,640 Beth Israel Deaconess Medical Center. She has a new book out. 29 00:01:53,760 --> 00:01:55,840 I think you guys are gonna love this one. It's 30 00:01:55,879 --> 00:01:59,480 called You've Been Pooping All Wrong, how to Make Your 31 00:01:59,519 --> 00:02:02,879 Bowel move Movements a Joy. It was just in time 32 00:02:03,040 --> 00:02:07,760 for me prior to my endoscopy and colonoscopy, So yeah, 33 00:02:07,760 --> 00:02:10,759 we're gonna go there without any further ado. 34 00:02:11,280 --> 00:02:17,120 Speaker 2: Here she is doctor Tricia Pasricha. Well, Tricia, thank you 35 00:02:17,199 --> 00:02:18,560 so much for joining me today. 36 00:02:19,479 --> 00:02:21,319 Speaker 3: Thanks for having me on. Glad to be here. 37 00:02:21,719 --> 00:02:24,080 Speaker 1: Yeah, I'm excited to talk about your new book, You've 38 00:02:24,120 --> 00:02:27,639 Been Pooping All Wrong, how to Make Your Bowel Movements 39 00:02:27,680 --> 00:02:31,639 a Joy. And it's funny because I often do you 40 00:02:31,719 --> 00:02:35,919 know where in the bookstore they are shelving your book? 41 00:02:35,960 --> 00:02:39,360 Speaker 2: Is it under medicine. Is it under It's not self help, 42 00:02:39,520 --> 00:02:39,759 is it. 43 00:02:40,319 --> 00:02:43,719 Speaker 4: I've seen it everywhere. It is a little bit of everything. 44 00:02:43,759 --> 00:02:45,719 It is a little self help, it's a little science, 45 00:02:45,759 --> 00:02:48,280 it's a little hardcore medicine. So I've seen it tucked 46 00:02:48,280 --> 00:02:50,360 away in a corner in the back. I've seen it 47 00:02:50,400 --> 00:02:52,439 at the shelves in the very front. I've seen it 48 00:02:52,479 --> 00:02:55,719 in medicine. I've seen it in advice. Depends on the 49 00:02:55,719 --> 00:02:56,759 whim of the bookseller. 50 00:02:56,840 --> 00:03:01,680 Speaker 1: Yes, yeah, So I tend to like as a show 51 00:03:01,680 --> 00:03:05,080 that started out She's like what fifteen years ago, as 52 00:03:05,080 --> 00:03:08,479 a science show, and it was very heavy like physics 53 00:03:08,479 --> 00:03:13,800 and chemistry and biology, and then evolved over the course 54 00:03:13,840 --> 00:03:16,680 of you know, my own interests and my own academic 55 00:03:16,759 --> 00:03:20,159 journey into a show that focuses a lot more on 56 00:03:20,479 --> 00:03:23,360 probably social sciences and social justice and things like that. 57 00:03:23,599 --> 00:03:25,840 One of the things that I tend not to do, 58 00:03:26,400 --> 00:03:29,039 because I myself am a psychologist, is I tend not 59 00:03:29,120 --> 00:03:29,719 to have like. 60 00:03:29,840 --> 00:03:31,879 Speaker 2: Self help authors on the show. 61 00:03:32,199 --> 00:03:36,120 Speaker 1: There's a whole industry, right, you know, news you can 62 00:03:36,240 --> 00:03:40,280 use and very often touted by people without credentials and 63 00:03:40,319 --> 00:03:42,879 and with you know, the quick fix that they're trying 64 00:03:42,919 --> 00:03:45,599 to sell but that is not what this book is. 65 00:03:46,039 --> 00:03:48,319 Even though the subheading is how to make your bowel 66 00:03:48,360 --> 00:03:54,599 movements and joy, this book is is really a book coming, 67 00:03:54,840 --> 00:03:58,840 you know, direct to you from an assistant professor of 68 00:03:58,960 --> 00:04:02,360 medicine at Horror. Also, you do have a lot of 69 00:04:02,479 --> 00:04:08,800 public kind of health and science communication chops because you 70 00:04:08,879 --> 00:04:12,840 do the Ask a Doctor column for the Washington Post. 71 00:04:13,560 --> 00:04:16,240 So oh, and of course you are the director of 72 00:04:16,279 --> 00:04:19,199 the Institute for Gut Brain Research at Beth Israel. So 73 00:04:19,319 --> 00:04:23,680 I think you've got all bases covered here. Clinical medicine, 74 00:04:23,680 --> 00:04:27,160 so the practice side, the teaching, the research side, but 75 00:04:27,199 --> 00:04:29,519 also communicating to a broader audience. 76 00:04:30,759 --> 00:04:34,639 Speaker 4: Yeah, I'm exactly with you. I tend to run in 77 00:04:34,680 --> 00:04:36,920 the opposite direction when someone tells me that they have 78 00:04:36,959 --> 00:04:40,439 a quick fix for almost anything, and I probably have 79 00:04:40,839 --> 00:04:43,920 like maybe just a handful of those in like the 80 00:04:44,079 --> 00:04:47,560 entire topic of gut health. But this book does, you know, 81 00:04:47,600 --> 00:04:49,800 I think a lot of different things. There's a big 82 00:04:49,839 --> 00:04:52,079 section that is just about the gut brain connection. That's 83 00:04:52,120 --> 00:04:54,920 what I study, that's what my lab focuses on. And 84 00:04:54,959 --> 00:04:58,439 then there are practical tools and tips that can't help 85 00:04:58,480 --> 00:05:00,759 you and can help actually anyone whos struggling with their 86 00:05:00,759 --> 00:05:02,680 bowel habits. So it's a little bit of a little 87 00:05:02,680 --> 00:05:05,240 bit of everything. I think everyone poop, so there is 88 00:05:05,240 --> 00:05:06,759 something in there for everyone to learn. 89 00:05:08,240 --> 00:05:10,360 Speaker 1: Yeah, yeah, I think so too. I think so even 90 00:05:10,360 --> 00:05:12,680 if they have alternate ways of pooping. 91 00:05:12,720 --> 00:05:14,279 Speaker 2: I do. I work in a hospital as well, and 92 00:05:14,319 --> 00:05:15,519 I see a lot of people who. 93 00:05:15,319 --> 00:05:19,079 Speaker 1: Have ostomes and and other you know, options that they've 94 00:05:19,079 --> 00:05:22,000 had to have due to surgeries or genetic issues, but 95 00:05:22,040 --> 00:05:24,800 of course they're still a poop. And so, you know, 96 00:05:25,000 --> 00:05:31,920 I notice that in a lot of kind of wellness pseudoscience, 97 00:05:32,639 --> 00:05:36,439 the gut brain has talked about a lot, like you 98 00:05:36,519 --> 00:05:40,240 hear a lot about sort of kind of like made 99 00:05:40,480 --> 00:05:45,600 up or not very evidenced based diagnoses like leaky gut syndrome. 100 00:05:45,959 --> 00:05:46,959 Speaker 2: I hear a lot of my friends. 101 00:05:47,000 --> 00:05:48,720 Speaker 1: I live out here in La right, so I hear 102 00:05:48,759 --> 00:05:51,920 a lot of people talking about how they need to 103 00:05:52,240 --> 00:05:55,040 you know, they have a fungal overload or they need 104 00:05:55,079 --> 00:05:56,800 to kelate. The animal is like, oh god, oh god, 105 00:05:56,839 --> 00:06:00,600 this rabbit hole is so scary. And so what a winfield? 106 00:06:00,759 --> 00:06:05,319 You work in an academic and clinical area that has 107 00:06:05,439 --> 00:06:10,519 been like your language has been really co opted by 108 00:06:10,759 --> 00:06:14,480 Huckster's by Charlatans by pseudoscientists to try and make a 109 00:06:14,480 --> 00:06:16,959 buck in the alternative wellness industry, hasn't it? 110 00:06:17,680 --> 00:06:19,959 Speaker 4: Yeah, I know you've hit the thing on the nail. 111 00:06:20,079 --> 00:06:23,439 Gut health is really like hashtag gut health has really 112 00:06:23,560 --> 00:06:27,240 taken on a life of its own, and I see 113 00:06:27,279 --> 00:06:30,319 and I understand why that has happened. I mean, gut 114 00:06:30,399 --> 00:06:35,079 health problems, broadly speaking, affect a huge portion of our population. 115 00:06:35,319 --> 00:06:38,839 And a big problem that I encounter as someone who 116 00:06:38,959 --> 00:06:43,360 specializes in gut brain connection is that we don't do 117 00:06:43,399 --> 00:06:46,959 a good job I think of explaining what is wrong 118 00:06:47,040 --> 00:06:49,199 in a lot of these disorders, like, for example, irritable 119 00:06:49,240 --> 00:06:52,319 bowstndrom is one of the most common disorders that I 120 00:06:52,360 --> 00:06:54,319 see every day in our clinic. It effects about fifteen 121 00:06:54,319 --> 00:06:57,160 percent of the population. But when I meet patients for 122 00:06:57,199 --> 00:07:00,000 the first time, a lot of them will have been told, oh, 123 00:07:00,120 --> 00:07:02,720 IBS means nobody knows. 124 00:07:02,519 --> 00:07:06,519 Speaker 2: What's going on, exclusion. 125 00:07:06,399 --> 00:07:09,720 Speaker 4: Exactly, and there's no treatment for it. We have no 126 00:07:09,800 --> 00:07:12,120 idea what it is. So where do they turn? 127 00:07:12,319 --> 00:07:12,879 Speaker 3: Online? 128 00:07:12,879 --> 00:07:16,920 Speaker 4: And online they've actually done this study. They have looked 129 00:07:16,920 --> 00:07:20,519 at how IBS is talked about on TikTok. And of course, 130 00:07:20,879 --> 00:07:24,279 the majority of viral videos do not come from healthcare providers. 131 00:07:24,319 --> 00:07:25,519 Speaker 3: They come from. 132 00:07:25,399 --> 00:07:30,959 Speaker 4: Patients or patients influencers who are being supported by a 133 00:07:31,000 --> 00:07:33,120 supplement company and who are saying, hey, by the way, 134 00:07:33,319 --> 00:07:36,279 this supplement really worked for me. And when you hear 135 00:07:36,319 --> 00:07:40,160 somebody really confidently telling you, one, here's exactly what your 136 00:07:40,160 --> 00:07:42,279 problem is. Maybe it's leaky gut, you know, like, maybe 137 00:07:42,279 --> 00:07:44,240 it's whatever it is, Like I know what this is, 138 00:07:44,319 --> 00:07:47,600 and now here I have a solution and I'm telling 139 00:07:47,639 --> 00:07:48,879 you it worked great for me. 140 00:07:49,240 --> 00:07:50,560 Speaker 3: I mean, how enticing is that? 141 00:07:51,040 --> 00:07:54,199 Speaker 4: And and for me, it's just a communication gap. Because 142 00:07:54,920 --> 00:07:59,000 we know what the molecular and cellular abnormalities are in IBS. 143 00:07:59,439 --> 00:08:01,560 Somehow that's up making its way to the patients. And 144 00:08:01,560 --> 00:08:06,000 we also have randomized control trials and fantastic treatments for IBS. Again, 145 00:08:06,079 --> 00:08:08,800 those treatments are not the ones at all that are 146 00:08:08,839 --> 00:08:11,360 being talked about online and so and IBS is just 147 00:08:11,399 --> 00:08:14,959 one of so many examples of gut health issues that 148 00:08:15,399 --> 00:08:19,240 there's this multi billion dollar industry that is praying on 149 00:08:19,279 --> 00:08:24,399 people's desperation and profiting from it. And it's it's something 150 00:08:24,439 --> 00:08:27,360 that I think about every single day in my work. 151 00:08:28,240 --> 00:08:32,240 Speaker 1: Yeah, so you have both an MD and an MPH. 152 00:08:32,440 --> 00:08:34,919 Tell me a little bit about you know, what you 153 00:08:35,039 --> 00:08:39,000 studied in school before you went to medical school, and 154 00:08:39,080 --> 00:08:42,480 what you specialized in through your medical training. 155 00:08:43,200 --> 00:08:43,559 Speaker 3: Yeah. 156 00:08:43,679 --> 00:08:46,200 Speaker 4: I So there was probably never a time in my 157 00:08:46,240 --> 00:08:48,720 life when I didn't want to be a gastroentrologist, which 158 00:08:48,720 --> 00:08:53,039 I know sounds really wacky, but most people that sounds 159 00:08:53,039 --> 00:08:54,960 really bizarre. But it won't sound bizarre if you know 160 00:08:55,080 --> 00:08:58,279 that my dad was also a gastrotrologist, and he was 161 00:08:58,320 --> 00:09:00,440 a researcher. So when I even before before I went 162 00:09:00,440 --> 00:09:04,440 to med school, he was studying the gut brain connection 163 00:09:04,600 --> 00:09:06,600 at a time when that field was really. 164 00:09:06,360 --> 00:09:08,120 Speaker 3: Starting to crystallize for the first time. 165 00:09:08,200 --> 00:09:10,279 Speaker 4: This was in the nineteen nineties and early two thousands, 166 00:09:10,279 --> 00:09:12,679 so it was a really cool and exciting time, and 167 00:09:12,799 --> 00:09:16,360 he was still passionate about his work and passed on 168 00:09:16,519 --> 00:09:19,200 that excitement to me and my siblings. Although all of 169 00:09:19,200 --> 00:09:21,519 my siblings again they ran in the other direction screaming 170 00:09:21,519 --> 00:09:23,799 they did not want to be doctors. Somehow I decided 171 00:09:23,799 --> 00:09:26,879 to follow his footsteps. But when I went to medicine, 172 00:09:27,000 --> 00:09:28,799 I knew I wanted to do GI because I loved 173 00:09:28,799 --> 00:09:32,360 it so much, and I wanted to do research too. 174 00:09:32,440 --> 00:09:35,399 I mean, I think the thing about the gut brain connection, 175 00:09:35,440 --> 00:09:37,159 and we can talk a lot about it. I know 176 00:09:37,320 --> 00:09:40,519 that that phrase feels really vague, and it also like 177 00:09:40,639 --> 00:09:43,879 is like something that my world means a lot, and 178 00:09:43,919 --> 00:09:46,000 in a way it means like very little too, you know, 179 00:09:46,039 --> 00:09:47,799 like the way it gets talked about like everything is 180 00:09:47,799 --> 00:09:48,639 the gut brain connection. 181 00:09:48,679 --> 00:09:50,480 Speaker 3: Everything's your microbiome, you know. 182 00:09:51,200 --> 00:09:51,799 Speaker 2: But there was. 183 00:09:51,799 --> 00:09:55,039 Speaker 4: Really so much that we've understood about it, and yet 184 00:09:55,080 --> 00:09:57,480 also so much that we need to still learn about it. 185 00:09:57,559 --> 00:09:59,799 And so I knew I wanted to do research, but 186 00:10:01,039 --> 00:10:04,440 I spent some time doing basic science. I worked at 187 00:10:04,440 --> 00:10:08,279 the NIH. I actually lived in the NIH like cloister 188 00:10:08,360 --> 00:10:10,799 building for a year of my life. It was delightful, 189 00:10:11,600 --> 00:10:14,360 and I was working with mice and living with other students. 190 00:10:14,360 --> 00:10:17,000 But then I ultimately decided that that wasn't how I 191 00:10:17,039 --> 00:10:18,519 wanted to spend the rest of my life. I wanted 192 00:10:18,559 --> 00:10:21,360 to do more translational and epidemiological research. So that's why 193 00:10:21,360 --> 00:10:24,000 I got the MPH, And the reason I did that 194 00:10:24,240 --> 00:10:29,679 was to really one understand how these large cohort studies 195 00:10:29,720 --> 00:10:32,600 are done, because that's a big way that we can 196 00:10:32,759 --> 00:10:38,039 do some hypothesis driving research. For me, that meant I 197 00:10:38,080 --> 00:10:41,279 had to do a deep dive into biostatistics and epidemiology 198 00:10:42,039 --> 00:10:43,960 and I spent a year. And there's like lots of 199 00:10:43,960 --> 00:10:47,279 different ways you can do an MPH. Some people study 200 00:10:47,559 --> 00:10:50,720 more on the social sciences side and ethics. Mine was 201 00:10:50,759 --> 00:10:54,000 really more into the epidemiology and biostatistic side of things. 202 00:10:54,519 --> 00:10:58,039 But it taught me how to use these biostatistical methods 203 00:10:58,080 --> 00:11:00,960 to do my own research studies later when I got 204 00:11:00,960 --> 00:11:04,120 my own funding from the NIH. So now I'm studying, 205 00:11:04,200 --> 00:11:08,799 of all things, Parkinson's disease. And Parkinson's disease is one 206 00:11:08,799 --> 00:11:10,960 of those things that a lot of people are like, wait, 207 00:11:11,000 --> 00:11:14,320 why are you, as a gastroentrologist studying that, of all things? 208 00:11:14,919 --> 00:11:19,519 And it's because Parkinson's disease is one of those diseases 209 00:11:19,559 --> 00:11:23,080 that fits so squarely within the gut brain axis. It's 210 00:11:23,120 --> 00:11:25,399 the disease that we used to think of as being 211 00:11:25,399 --> 00:11:28,519 primarily within the brain, and now, over the last couple 212 00:11:28,559 --> 00:11:30,639 of decades, we're realizing that at least for a subset 213 00:11:30,679 --> 00:11:33,080 of patients, it probably starts in the gut, and we're 214 00:11:33,120 --> 00:11:36,679 understanding how those two systems, the central nervous system and 215 00:11:36,759 --> 00:11:39,799 the enteric nervous system, which is the millions of neurons 216 00:11:39,840 --> 00:11:41,759 that live in our gut, how they communicate with each other, 217 00:11:41,840 --> 00:11:45,480 and how possibly diseases can spread between them. And so 218 00:11:45,559 --> 00:11:47,840 that's what I study now, and I do. It's like 219 00:11:47,840 --> 00:11:50,200 you said, I do a little bit of everything. I 220 00:11:50,279 --> 00:11:54,759 have a lab where I study large population databases. I 221 00:11:54,879 --> 00:11:56,600 bring that back to patients that I see in my 222 00:11:56,639 --> 00:11:59,480 clinic and I recruit them for my trials. We're looking 223 00:11:59,519 --> 00:12:05,360 at bios specimen. And then in my limited spare time, 224 00:12:05,399 --> 00:12:07,679 I also write the Aska Doctor column, where I try 225 00:12:07,679 --> 00:12:09,919 to take some of that data and take some of 226 00:12:09,919 --> 00:12:12,360 the questions that my own patients are giving me, like 227 00:12:12,440 --> 00:12:14,159 the kind of things that you've been talking about, like 228 00:12:14,240 --> 00:12:16,080 leaki gut. People come in and ask me about that, 229 00:12:16,120 --> 00:12:18,720 and I say, okay, like this is a great question. 230 00:12:18,840 --> 00:12:21,240 More people should know what leaki gut is and what 231 00:12:21,360 --> 00:12:22,320 leaki gut is not. 232 00:12:23,519 --> 00:12:25,440 Speaker 3: But it's the kind of thing that you know, you 233 00:12:25,480 --> 00:12:26,399 have fifteen minutes with. 234 00:12:26,360 --> 00:12:28,799 Speaker 4: A doctor in an appointment, like you're going to talk 235 00:12:28,840 --> 00:12:30,480 about your kolonosko, but you're not going to talk to 236 00:12:30,480 --> 00:12:33,039 them about supplements for leaki gut and instead you're gonna 237 00:12:33,039 --> 00:12:35,440 get that information on TikTok. So I try to meet 238 00:12:35,480 --> 00:12:37,919 patients where they are, which is online, and it is 239 00:12:37,960 --> 00:12:39,559 on TikTok, it is on Instagram. 240 00:12:40,399 --> 00:12:45,240 Speaker 1: Yeah, yeah, you know it's it's there's so much to unpack, 241 00:12:45,279 --> 00:12:48,080 and I'm curious how I even want to like structure 242 00:12:48,159 --> 00:12:48,879 this and dive in. 243 00:12:48,960 --> 00:12:50,879 Speaker 2: But I'm gonna get personal. I often like to get 244 00:12:50,919 --> 00:12:51,519 personal on the. 245 00:12:51,519 --> 00:12:54,879 Speaker 1: Show, and I'm going to think about the sort of archetype. 246 00:12:54,960 --> 00:12:59,440 I'm assuming you know that you have certain types of 247 00:12:59,480 --> 00:13:02,639 patients that you see, certain types of individuals who both 248 00:13:02,679 --> 00:13:07,039 come to the clinic but also are consuming content online. 249 00:13:07,639 --> 00:13:11,799 I would describe myself personally as somebody with just like 250 00:13:12,080 --> 00:13:14,799 I don't know, like an iron gut, Like I can 251 00:13:14,840 --> 00:13:18,200 eat whatever I want. I like my poops are pretty normal. 252 00:13:18,759 --> 00:13:21,559 Sometimes my poops aren't normal, but I never get like 253 00:13:21,919 --> 00:13:27,200 stressed by that, because that's what life is. I love dairy. 254 00:13:27,360 --> 00:13:30,320 My body's like dairy. I feel great after I eat dairy, 255 00:13:30,320 --> 00:13:33,759 which is like just weird. And then I, for some reason, 256 00:13:33,879 --> 00:13:39,559 have had a long history of dating serious partners who 257 00:13:39,639 --> 00:13:44,000 have like the equal and opposite problem is me their 258 00:13:44,039 --> 00:13:47,799 guts are there, and I personally believe that there is 259 00:13:47,840 --> 00:13:51,039 a deep connection to their mental health and to their 260 00:13:51,039 --> 00:13:55,480 anxiety disorders between their gut issues, and a lot of 261 00:13:55,519 --> 00:14:01,200 it becomes can be a challenge in relationships when it's confusing. 262 00:14:02,120 --> 00:14:08,919 How much of the gut concern or preoccupation is based 263 00:14:09,039 --> 00:14:14,320 on intolerable symptoms, which is completely fair, nobody should have 264 00:14:14,360 --> 00:14:17,320 to suffer at the hands of their gut, And how 265 00:14:17,399 --> 00:14:20,679 much of it is based on worry or an extra 266 00:14:20,960 --> 00:14:25,559 layer of interpretation of what some of their symptomatology means. 267 00:14:26,000 --> 00:14:27,519 Speaker 2: So I'm curious from you. 268 00:14:27,759 --> 00:14:32,279 Speaker 1: There is just a certain amount of like human variability, right, 269 00:14:32,279 --> 00:14:34,120 Like we all want to be somewhat normal, but every 270 00:14:34,159 --> 00:14:35,960 once in a while you're gonna get diarrhea and it 271 00:14:36,000 --> 00:14:36,960 doesn't mean you're dying. 272 00:14:38,279 --> 00:14:42,200 Speaker 4: Yeah, you've hit on I think one of the biggest 273 00:14:42,240 --> 00:14:45,240 topics in the field, which is how much of our 274 00:14:45,320 --> 00:14:48,799 gut troubles start in the brain, how much of it 275 00:14:48,879 --> 00:14:51,080 start in the gut? How much of our brain troubles 276 00:14:51,080 --> 00:14:52,879 start in the brain, how much of it starts in 277 00:14:52,919 --> 00:14:55,919 the gut? Right, And you've also hit on, like I think, 278 00:14:55,960 --> 00:14:59,000 like a bigger sociological problem, which is why is it 279 00:14:59,080 --> 00:15:01,840 that people would gut trouble always marry people without gut 280 00:15:01,879 --> 00:15:06,519 trouble advice time, you know, like people will come in 281 00:15:06,559 --> 00:15:09,759 to my clinic having been dragged in by their partners 282 00:15:09,799 --> 00:15:12,000 and they're like, no, I'm completely normal, I've normal habits, 283 00:15:12,039 --> 00:15:13,840 and their partners like, are you kidding me? 284 00:15:14,279 --> 00:15:16,919 Speaker 3: You are not normal? And sometimes you don't know. 285 00:15:17,039 --> 00:15:19,440 Speaker 4: I mean, I think this is like our society's problem 286 00:15:19,440 --> 00:15:21,840 because we just don't talk about this as much as 287 00:15:21,840 --> 00:15:23,679 we should. But you just don't know until you marry 288 00:15:23,759 --> 00:15:27,080 someone how different your bowel habits are from other people. 289 00:15:27,080 --> 00:15:28,919 And then you're like, wait a minute, like you you 290 00:15:29,159 --> 00:15:32,200 don't have to poop every time you drink milk. 291 00:15:32,000 --> 00:15:34,320 Speaker 3: Like right, or like this whole time. 292 00:15:34,519 --> 00:15:37,679 Speaker 1: Or like, dude, you should not spend forty five minutes 293 00:15:37,679 --> 00:15:41,639 in the bathroom like yeah, yeah, every event. 294 00:15:41,799 --> 00:15:43,039 Speaker 3: Yeah it's not too you are. 295 00:15:43,159 --> 00:15:45,159 Speaker 4: It's like how your brothers were too, and you think 296 00:15:45,240 --> 00:15:48,399 that's fine and actually, no, my friend, that's not normal. 297 00:15:48,519 --> 00:15:51,960 But you know, like if we were to say, you know, 298 00:15:52,240 --> 00:15:54,960 the way, okay, the way the gut brain connection had 299 00:15:55,000 --> 00:15:58,679 been thought of for more than one hundred years was 300 00:15:58,879 --> 00:16:02,559 really in terms of how the brain impacted the gut. 301 00:16:02,960 --> 00:16:05,080 So like if you go back in time, there were 302 00:16:05,080 --> 00:16:09,000 these accounts in the late eighteen hundreds of doctors who 303 00:16:09,120 --> 00:16:12,720 observed through whether it was like in a war zone 304 00:16:12,759 --> 00:16:14,879 where people had injuries and they could actually like look. 305 00:16:14,759 --> 00:16:15,320 Speaker 3: In the abdomen. 306 00:16:15,360 --> 00:16:19,320 Speaker 4: They would see that when people were under duress, under stress, 307 00:16:19,879 --> 00:16:22,399 your gut starts to move. It increases what we call 308 00:16:22,480 --> 00:16:24,919 the motility or the movement of your gut. And that 309 00:16:25,080 --> 00:16:27,279 is the part I think of the gut brain connection 310 00:16:27,399 --> 00:16:30,399 that's probably the most intuitive to most people because we 311 00:16:30,440 --> 00:16:32,200 live with that in day to day life, Like when 312 00:16:32,200 --> 00:16:37,519 we're stressed, we perceived these changes almost immediately in our guts. 313 00:16:38,120 --> 00:16:40,679 And this is something that I studied and got me 314 00:16:40,720 --> 00:16:42,600 really excited in the field, Like actually way back in 315 00:16:42,679 --> 00:16:44,720 high school. But I was trying to understand what causes 316 00:16:44,759 --> 00:16:47,080 gut feelings, like why do people get those butterflies in 317 00:16:47,120 --> 00:16:50,600 their stomachs when they're stressed. And what I found is 318 00:16:50,600 --> 00:16:55,840 that when we're stressed, we produce this hormone that starts 319 00:16:55,879 --> 00:16:58,240 from signaling through our amygdala, which is you know, as 320 00:16:58,240 --> 00:17:00,759 you know, this emotional processing hub our brains, but it 321 00:17:00,799 --> 00:17:04,720 sends this cascade eventually, this hormone called cordicotroph and releasing 322 00:17:04,720 --> 00:17:07,759 hormone actually grinds the stomach to a halt. It grinds 323 00:17:07,839 --> 00:17:09,920 that movement to a halt, so you're not contracting at 324 00:17:09,920 --> 00:17:12,119 a regular rhythm, and you go into this chaotgorithm, which 325 00:17:12,160 --> 00:17:14,480 for some people feels actually like you're suddenly feeling a 326 00:17:14,519 --> 00:17:17,200 little nauseated because your stomach's not moving things forward. 327 00:17:17,759 --> 00:17:19,920 Speaker 1: But it was this kind of like during a fight 328 00:17:20,000 --> 00:17:24,119 or flight experience, like when you're actually acutely stressed, your 329 00:17:24,160 --> 00:17:26,559 body is like I don't need to put my resources 330 00:17:26,559 --> 00:17:27,960 into digestion right now. 331 00:17:28,680 --> 00:17:32,400 Speaker 4: Yes, that's exactly right. And there's actually an interesting A 332 00:17:32,440 --> 00:17:35,680 lot of this came from other labs out of UCLA, 333 00:17:35,759 --> 00:17:38,920 and I ask someone like, evolutionarily, why is it that 334 00:17:39,839 --> 00:17:43,960 we when we're stressed, our stomach stop moving, but paradoxically, 335 00:17:44,079 --> 00:17:46,599 our colons start to contract. The final part of our 336 00:17:46,640 --> 00:17:49,400 colon starts to contract for quick which is also why, yes, 337 00:17:49,400 --> 00:17:53,200 you feel nauseated, but yes, you also often have to boop, 338 00:17:54,039 --> 00:17:55,720 like right about to go on stage, and it's like, wait, 339 00:17:55,720 --> 00:17:56,200 what's going on? 340 00:17:56,240 --> 00:17:59,039 Speaker 1: And that's one hundred percent the only time I have that. 341 00:17:59,440 --> 00:18:00,960 I don't have it anymore. But when I used to 342 00:18:00,960 --> 00:18:02,960 be a singer for some reason. Oh only when I 343 00:18:02,960 --> 00:18:05,680 would say the minute before I go on stage to 344 00:18:05,680 --> 00:18:07,519 saying I'm gonna poop myself. And then of course it 345 00:18:07,559 --> 00:18:09,119 goes away once you're doing it. 346 00:18:10,799 --> 00:18:12,079 Speaker 3: You didn't have to poop after all. 347 00:18:12,079 --> 00:18:14,880 Speaker 4: Like it only hit before my turn a karaoke Like, yeah, 348 00:18:14,960 --> 00:18:17,400 this is a real phenomena, and we all like I 349 00:18:17,480 --> 00:18:18,359 used to get this like. 350 00:18:18,319 --> 00:18:19,720 Speaker 3: Before big presentations. 351 00:18:19,920 --> 00:18:23,279 Speaker 4: And what actually also is happening, and this is something 352 00:18:23,359 --> 00:18:27,519 I learned, is that we actually do when we're stressed, 353 00:18:27,640 --> 00:18:31,400 experience this thing called increased intestinal permeability where the cells 354 00:18:31,400 --> 00:18:34,359 that are lining the gut actually do open up their 355 00:18:34,400 --> 00:18:38,680 little gaps that open up between those cells. And this 356 00:18:39,000 --> 00:18:42,599 concept of increased intestinal permeability that happens with stress, it 357 00:18:42,640 --> 00:18:44,960 actually happens when we eat. Sometimes it happens to all 358 00:18:44,960 --> 00:18:47,279 this during the day. That's the concept that is real. 359 00:18:47,359 --> 00:18:50,599 It's physiological that has been co opted by social media 360 00:18:50,640 --> 00:18:53,119 to mean leaky gut, and it's taken on like a 361 00:18:53,200 --> 00:18:56,720 lot of other interpretations and meanings and values that that 362 00:18:56,920 --> 00:18:58,559 it didn't really start as. 363 00:18:58,720 --> 00:19:02,640 Speaker 1: But wait, so this is a normal physiologic function that 364 00:19:02,759 --> 00:19:06,680 happens during stressful periods. But also just as as the 365 00:19:06,759 --> 00:19:09,759 overall function of digestion, and people talk about it like 366 00:19:09,759 --> 00:19:10,799 it's a syndrome. 367 00:19:11,759 --> 00:19:14,400 Speaker 4: Yes, and in fact all of us at some point 368 00:19:14,440 --> 00:19:19,200 during the day would have measurable increases in our intestinal 369 00:19:19,240 --> 00:19:24,039 permeability that it turns out when we're stressed. The hypothesis 370 00:19:24,119 --> 00:19:27,880 is that because this is happening, and it's you know, 371 00:19:27,920 --> 00:19:30,960 in theory like allowing the passage of molecules in and out, 372 00:19:31,000 --> 00:19:35,039 that can help protect us. Because this is occurring during 373 00:19:35,119 --> 00:19:37,759 times of stress, it would actually behoove you. It would 374 00:19:37,759 --> 00:19:40,960 help your body to try to eliminate all food and 375 00:19:41,000 --> 00:19:44,880 all antigens out by pooping, by like not pushing more 376 00:19:44,920 --> 00:19:47,720 food downwards to your colon. Because we know that you 377 00:19:47,759 --> 00:19:51,039 have increased intestinal permeability, we don't want any antigens to 378 00:19:51,079 --> 00:19:53,440 come in and potentially enter the blood dream during this 379 00:19:53,480 --> 00:19:55,319 time when we're particularly vulnerable. 380 00:19:55,359 --> 00:19:56,839 Speaker 3: So that's the idea about. 381 00:19:56,599 --> 00:20:01,079 Speaker 4: Why our guts suddenly go a ride during moments of stress. 382 00:20:01,480 --> 00:20:02,680 Speaker 3: But it's usually short lived. 383 00:20:03,519 --> 00:20:06,319 Speaker 4: It's usually not something that will stick around for the 384 00:20:06,359 --> 00:20:08,000 next several hours. Like you said, as soon as your 385 00:20:08,119 --> 00:20:11,079 like segment is over on stage, suddenly you don't have 386 00:20:11,079 --> 00:20:13,039 to poop after all and things kind of go back 387 00:20:13,079 --> 00:20:16,920 to normal, but there is as you said, this idea 388 00:20:16,960 --> 00:20:19,880 of leaky gut is a chronic syndrome. And you know, 389 00:20:19,960 --> 00:20:21,920 like I've seen these videos on social media too where 390 00:20:21,960 --> 00:20:23,720 someone will be like, do you have brain fog? 391 00:20:23,839 --> 00:20:24,519 Speaker 3: Are you bloated? 392 00:20:25,039 --> 00:20:27,759 Speaker 4: Must be leaky gut, and then you're like, wait, yeah, 393 00:20:27,799 --> 00:20:28,880 I am bloated. 394 00:20:28,559 --> 00:20:29,920 Speaker 3: I do have brain frog. 395 00:20:29,920 --> 00:20:34,079 Speaker 4: Because these are very common problems that people experience, and 396 00:20:34,119 --> 00:20:36,319 then somebody gives you a concrete answer and it kind 397 00:20:36,359 --> 00:20:39,519 of has this certainly sounds scientific when they explain like 398 00:20:39,559 --> 00:20:42,759 what could be happening. It's easy to latch onto this 399 00:20:42,759 --> 00:20:45,039 as an idea, but it's really you know, it's like, 400 00:20:45,599 --> 00:20:47,880 for example, if you have an infection and your white 401 00:20:47,880 --> 00:20:50,640 blood cell count is elevated, the problem is not that 402 00:20:50,680 --> 00:20:52,680 your white blood cell count is elevated. That's going to 403 00:20:52,720 --> 00:20:54,880 be elevated in a lot of different conditions. The problem 404 00:20:54,920 --> 00:20:57,160 is the infection and we just anchor on the leaky 405 00:20:57,200 --> 00:21:00,960 gut part of it. We're missing what's what is driving it. 406 00:21:01,000 --> 00:21:03,599 And that's if you try to do yeah, like, don't 407 00:21:03,640 --> 00:21:06,240 solve the leaky gut, try to solve what is the 408 00:21:06,359 --> 00:21:09,200 upstream driver of this? Issue, but instead we've landed there, 409 00:21:09,200 --> 00:21:10,920 we've anchored there, and then of course there's this whole 410 00:21:10,960 --> 00:21:13,960 industry of unregulated supplements that will try to solve it, 411 00:21:13,960 --> 00:21:16,079 which you know there's not great data for. 412 00:21:16,640 --> 00:21:19,559 Speaker 1: Right, So you've got a twofold problem here. You've got 413 00:21:20,000 --> 00:21:22,720 the preying on individuals, which we see all the time 414 00:21:22,720 --> 00:21:24,440 in the beauty industry and in a lot of like 415 00:21:24,519 --> 00:21:30,079 wellness industries, the praying of individuals by pathologizing a normal 416 00:21:30,519 --> 00:21:34,440 biological function. And then the secondary problem is maybe you 417 00:21:34,519 --> 00:21:37,359 are somebody who suffers from chronic stress and now we're 418 00:21:37,359 --> 00:21:40,000 talking you know, a Robert Sapalski wyzy bris don't get 419 00:21:40,079 --> 00:21:44,680 ulcers situation where like a lot of physiologic things are 420 00:21:44,720 --> 00:21:50,400 going wrong. But ultimately this quote normal biologic function does 421 00:21:50,480 --> 00:21:53,000 have a protective mechanism. This is part of your immune 422 00:21:53,039 --> 00:21:56,440 system and it's there to protect you. It's just chronic 423 00:21:56,519 --> 00:21:57,880 stress is really. 424 00:21:57,599 --> 00:21:58,519 Speaker 2: Bad for us. 425 00:21:58,960 --> 00:22:01,599 Speaker 1: And we have all of these acute functions that we've 426 00:22:01,640 --> 00:22:04,160 evolved that when we turn them on in the long 427 00:22:04,240 --> 00:22:07,440 term start to wreak havoc. But the problem there, you're right, 428 00:22:07,640 --> 00:22:11,880 is not solving the biological marker of the stress. It's 429 00:22:11,920 --> 00:22:13,519 reducing the stress. 430 00:22:14,920 --> 00:22:18,519 Speaker 4: Yeah, reducing the stress or I mean there's it's you know, 431 00:22:18,559 --> 00:22:23,000 in my world, bloating can happen for one hundred different reasons, 432 00:22:23,160 --> 00:22:25,880 brain fog fatigue can happen for a hundred different reasons. 433 00:22:26,079 --> 00:22:29,000 Of course, we'd oh, no, it could be stress, it 434 00:22:29,000 --> 00:22:32,200 could be something different, and I it's not. It's it's 435 00:22:32,240 --> 00:22:34,640 happened to me, like on more than one occasion that 436 00:22:34,759 --> 00:22:37,960 people have come to me having tried supplements at home 437 00:22:38,000 --> 00:22:40,279 for leaky gut, and it turns out they the whole 438 00:22:40,279 --> 00:22:43,160 time they had something like celiac disease, they had something 439 00:22:43,160 --> 00:22:46,640 that we could have ben should have diagnosed earlier if 440 00:22:46,640 --> 00:22:49,720 they had just come in to see a gastorentrologist and 441 00:22:49,720 --> 00:22:52,079 we had done sort of like a let's start from scratch, 442 00:22:52,160 --> 00:22:53,759 let's do this whole work up, rather than like let's 443 00:22:53,799 --> 00:22:56,279 anchor onto this idea that we saw that was so 444 00:22:56,400 --> 00:22:59,599 convincing on you know, want talk. And I think people 445 00:22:59,640 --> 00:23:04,319 forget sometimes that it's horrible it and a lot of 446 00:23:04,359 --> 00:23:08,440 these tests and supplements they feel really medical, like you know, 447 00:23:08,480 --> 00:23:12,279 like these microbiome testing kits or these supplements for leakigat. 448 00:23:11,960 --> 00:23:14,720 Speaker 3: They feel medical. But and yet like just to remember at. 449 00:23:14,599 --> 00:23:17,160 Speaker 4: The end of the days, you know, these are not 450 00:23:17,319 --> 00:23:20,200 regulated the same way as medications are. Like these they 451 00:23:20,240 --> 00:23:23,039 haven't undergone like phase one, two through four, all these 452 00:23:23,079 --> 00:23:26,240 clinical trials the way you think, even though the marketing 453 00:23:26,240 --> 00:23:30,400 and the conversation around them feels like hardcore science, sometimes 454 00:23:30,160 --> 00:23:31,240 it's actually not. 455 00:23:32,200 --> 00:23:35,359 Speaker 1: Yeah, And I think that's that's a larger point that 456 00:23:35,599 --> 00:23:37,799 is important to I will do the quick and dirty, 457 00:23:37,799 --> 00:23:39,759 because anybody who listens to my other show, The Skeptics 458 00:23:39,759 --> 00:23:41,480 Guide to the Universe, knows that we hound on this 459 00:23:41,559 --> 00:23:46,359 all the time. But like the very rhetoric that big 460 00:23:46,440 --> 00:23:49,519 pharma or big medicine doesn't want you to know, and 461 00:23:49,559 --> 00:23:51,799 here are the real things, and here are the things 462 00:23:51,799 --> 00:23:54,440 that I'm trying to sell you. The reason that that 463 00:23:54,640 --> 00:23:58,039 can work so well is because a lot of people 464 00:23:58,079 --> 00:24:02,400 do have difficult experience dances with the medical system. We 465 00:24:02,559 --> 00:24:05,359 know that you know, managed care is very problematic in 466 00:24:05,359 --> 00:24:11,920 this country. But ultimately, if there is a treatment available, 467 00:24:12,599 --> 00:24:16,640 your physician knows about it, and your physician can read 468 00:24:16,839 --> 00:24:22,279 about the trials that were undergone for that treatment or 469 00:24:22,279 --> 00:24:26,519 that procedure or whatever to become FDA approved. So the 470 00:24:26,519 --> 00:24:29,359 frustrating thing for me is when people go, oh, I'm 471 00:24:29,400 --> 00:24:34,920 over here, I'm quote alternative medicine. I'm offering you an alternative. Really, 472 00:24:34,960 --> 00:24:36,759 the doctors in big pharma are trying to get rich 473 00:24:36,839 --> 00:24:39,519 off of you, And I'm like, no, no, actually, that real 474 00:24:39,559 --> 00:24:43,000 treatment is subsidized by your insurance company. The thing they're 475 00:24:43,039 --> 00:24:44,880 trying to sell you will never be covered by your 476 00:24:44,880 --> 00:24:47,440 insurance because it is not a real treatment. 477 00:24:48,480 --> 00:24:51,400 Speaker 4: Yeah, and you pay hundreds and thousands of dollars. 478 00:24:51,599 --> 00:24:54,079 Speaker 2: Yeah. Yeah. And it's the very rhetoric. 479 00:24:54,240 --> 00:24:56,400 Speaker 1: It's sort of the trump of it all of like 480 00:24:57,119 --> 00:25:00,119 not me him, you know, it's like the very rhetorica. Well, 481 00:25:00,240 --> 00:25:03,880 really is that the medical system is predatory and all 482 00:25:03,920 --> 00:25:05,559 they want to do is make money and they don't 483 00:25:05,839 --> 00:25:09,680 when when they're doing the same thing and in some 484 00:25:09,720 --> 00:25:12,440 ways in an even more egregious way because it's the wild, 485 00:25:12,519 --> 00:25:12,960 wild West. 486 00:25:12,960 --> 00:25:13,720 Speaker 2: So that's my schpiel. 487 00:25:14,400 --> 00:25:19,160 Speaker 3: Yeah, I fully agree, I fully co sign your spield. 488 00:25:19,200 --> 00:25:21,599 Speaker 4: But you know, it raises a really good point, which 489 00:25:21,640 --> 00:25:25,000 is that you know, because this is this is how 490 00:25:25,039 --> 00:25:28,359 we framed this gut brain connection for so long. And 491 00:25:28,599 --> 00:25:31,000 I'm talking about like during the nineteen fifties, we were 492 00:25:31,039 --> 00:25:36,079 studying stress and constipation and diarrhea and motility. We really 493 00:25:36,240 --> 00:25:40,920 internalized this idea that problems in our gut are in 494 00:25:40,960 --> 00:25:45,519 our heads, and that was the conversation in mainstream medicine 495 00:25:45,559 --> 00:25:47,119 for a century. 496 00:25:47,160 --> 00:25:52,720 Speaker 3: Like I said, and it's hard because the last. 497 00:25:52,960 --> 00:25:58,039 Speaker 4: Twenty or so years, we have lots of experimental mechanistic 498 00:25:58,240 --> 00:26:03,200 data and couple with epidemiological studies that show that actually 499 00:26:03,359 --> 00:26:08,319 a lot of anxiety and depression and neurodegenerative disorders actually 500 00:26:09,000 --> 00:26:12,920 start in the gut and fuel the anxiety and depression 501 00:26:13,599 --> 00:26:17,319 rather than as a result of said anxiety and depression. 502 00:26:17,480 --> 00:26:21,000 But that narrative, that older narrative that this is all 503 00:26:21,000 --> 00:26:25,559 in your head, is so pervasive. It's what people hear, 504 00:26:25,839 --> 00:26:29,559 whether those words are explicitly used, that I get why 505 00:26:29,599 --> 00:26:34,640 they're turning towards somebody who listens, somebody who says, you know, 506 00:26:34,799 --> 00:26:38,200 you're not crazy, you have real problems, and here's the 507 00:26:38,240 --> 00:26:41,680 real solution, even though the real solutions are not real, 508 00:26:41,880 --> 00:26:44,759 and the problems are identifying are not the actual problems. 509 00:26:45,160 --> 00:26:48,160 It feels really validating to say, yeah, all of these 510 00:26:48,200 --> 00:26:51,920 doctors who before didn't believe me or thought that I need. 511 00:26:51,920 --> 00:26:55,480 What I needed was an antidepressant, and certainly maybe you 512 00:26:55,519 --> 00:26:57,720 did that would have helped, but it wasn't the whole picture. 513 00:26:58,000 --> 00:27:01,319 It is really validating to hear somebody say I have 514 00:27:01,359 --> 00:27:03,920 a solution that nobody's told you, and you suddenly feel 515 00:27:03,920 --> 00:27:06,839 like wait, like they have been gatekeeping. And so it's 516 00:27:06,839 --> 00:27:09,720 also this like big kind of social problem that we 517 00:27:09,759 --> 00:27:12,079 have to deal with in our field, Like it's a 518 00:27:12,119 --> 00:27:14,400 reckoning that we have to come with that our messaging 519 00:27:14,400 --> 00:27:18,519 has just been not deliberately incorrect. It was based on 520 00:27:19,119 --> 00:27:22,200 real data and real science. But the newer science, which 521 00:27:22,240 --> 00:27:24,480 is now not even that new. We're talking about like 522 00:27:24,519 --> 00:27:27,400 twenty thirty years old data, it just hasn't caught up 523 00:27:27,400 --> 00:27:29,599 in the popular popular mention culture. Because when I hear 524 00:27:29,599 --> 00:27:31,880 about the gut brain connection on social media. 525 00:27:31,519 --> 00:27:32,839 Speaker 3: It's still the same old stuff. 526 00:27:32,839 --> 00:27:37,119 Speaker 4: It's still people talking about stress and anxiety causing gut 527 00:27:37,160 --> 00:27:37,880 trouble and. 528 00:27:37,799 --> 00:27:38,799 Speaker 3: All of that is true. 529 00:27:38,799 --> 00:27:41,559 Speaker 4: But when you see the other side of it, how 530 00:27:41,559 --> 00:27:44,880 the gut influences the brain, it's either limited or it 531 00:27:44,960 --> 00:27:48,519 is oversimplified into stuff like oh, yeah, take two cups 532 00:27:48,519 --> 00:27:51,440 of blueberries a day, and you know what, use your 533 00:27:51,480 --> 00:27:53,839 risk of demension And it's like okay, you know, yes, 534 00:27:53,920 --> 00:27:57,279 it's a healthy eating pattern is absolutely associated with a 535 00:27:57,279 --> 00:27:59,359 lower risk of dimension, and there's a lot of data there, 536 00:27:59,359 --> 00:28:02,759 but it becomes so oversimplified that it's also easy to 537 00:28:02,799 --> 00:28:03,599 dismiss then too. 538 00:28:04,359 --> 00:28:08,319 Speaker 1: Yeah, I worry about the pendulum being too extreme on 539 00:28:08,519 --> 00:28:11,119 either side. And this is some you know, this is 540 00:28:11,160 --> 00:28:16,440 coming from somebody who's a clinical existentially oriented psychologist working in. 541 00:28:16,400 --> 00:28:17,839 Speaker 2: A medical establishment. 542 00:28:18,319 --> 00:28:24,240 Speaker 1: So like, I see what happens when we think about 543 00:28:24,279 --> 00:28:28,039 mental health in a purely medicalized way, and I also 544 00:28:28,079 --> 00:28:32,519 see what happens when we completely remove mental health from 545 00:28:32,599 --> 00:28:36,200 the equation, which should not happen. And so I'm so 546 00:28:36,440 --> 00:28:42,000 curious about how you, I guess, grapple with the fact 547 00:28:42,039 --> 00:28:46,400 that sometimes these things are inextricably linked. Of course, we 548 00:28:46,440 --> 00:28:48,759 want to validate people and say, yes, it's not all 549 00:28:48,759 --> 00:28:51,200 in your head. There's a lot going on here physiologically 550 00:28:51,440 --> 00:28:54,279 that we want to work on. And at the same time, 551 00:28:55,160 --> 00:29:01,240 if you are struggling with undiagnosed or untreated anxiety, or 552 00:29:01,279 --> 00:29:04,400 you have long had a lot of control issues around 553 00:29:04,400 --> 00:29:07,799 your bathroom habits, you may have developed a pretty severe 554 00:29:07,880 --> 00:29:13,559 anxiety disorder that is now related to your your digestive system, 555 00:29:13,880 --> 00:29:16,480 and both of those things have to be you know, 556 00:29:17,119 --> 00:29:19,559 grappled with totally. 557 00:29:19,759 --> 00:29:22,039 Speaker 4: And I think a lot of what I do when 558 00:29:22,119 --> 00:29:24,039 I see patients and just you know, to give you 559 00:29:24,079 --> 00:29:27,480 some context. Usually I'm not the first opinion, you know, 560 00:29:27,559 --> 00:29:30,400 like the way my clinic is structured. I'm very very specialized, 561 00:29:30,440 --> 00:29:32,720 So usually people will have seen a couple of different 562 00:29:32,720 --> 00:29:36,440 doctors before they get to me, And what I have. 563 00:29:36,400 --> 00:29:38,839 Speaker 3: To do is usually kind of rebuild a little bit of. 564 00:29:38,759 --> 00:29:42,319 Speaker 4: Trust and say a lot of what you're saying, and 565 00:29:42,359 --> 00:29:45,240 I'll give you, like one example that I often explain 566 00:29:45,279 --> 00:29:48,640 to people about how these things are linked. Take irritable 567 00:29:48,640 --> 00:29:51,799 bowels in because it's just such a kind of quintessential example. 568 00:29:52,920 --> 00:29:56,240 One of the things that we know through research studies, 569 00:29:56,279 --> 00:29:58,920 and you can take these pathological specimen and do the 570 00:29:58,960 --> 00:30:02,759 stains and find this is that the nerve cells in. 571 00:30:02,720 --> 00:30:05,039 Speaker 3: The gut specifically. 572 00:30:04,839 --> 00:30:08,240 Speaker 4: Are triggered at a lower threshold than in people who 573 00:30:08,240 --> 00:30:11,880 don't have irritable bowel syndrome, and these nerve cells then 574 00:30:11,920 --> 00:30:15,640 send pain signals up to the brain. For kind of 575 00:30:15,640 --> 00:30:19,319 the normal movements of digestion, like the gurgling of the 576 00:30:19,359 --> 00:30:22,720 food passing through. These are things that cause a little 577 00:30:22,720 --> 00:30:25,240 bit of distension in everybody, but we wouldn't perceive it. 578 00:30:25,279 --> 00:30:27,920 But if you have irritable bowel syndrome and your nerves 579 00:30:27,960 --> 00:30:31,599 are hyper sensitive, you're going to perceive that as painful. 580 00:30:31,960 --> 00:30:35,960 And there's a lot of reasons why this happens. Sometimes 581 00:30:35,960 --> 00:30:39,319 it's an infection, Like one out of four people who 582 00:30:39,359 --> 00:30:42,480 get something like neurovirus will go on to develop irritable 583 00:30:42,480 --> 00:30:45,319 bowl syndrome because there's been so much inflammation to those 584 00:30:45,359 --> 00:30:47,799 nerves that even when the virus itself is well out 585 00:30:47,839 --> 00:30:51,119 of your system, the nerves have been changed and damaged. 586 00:30:51,200 --> 00:30:52,319 Speaker 3: And I have a loved. 587 00:30:52,119 --> 00:30:55,440 Speaker 1: One who, yeah, who claims that like that, that is 588 00:30:55,599 --> 00:30:57,960 where like he had a really bad case of quote 589 00:30:58,039 --> 00:31:02,920 unquote food poisoning. Yes, ever since then he has to 590 00:31:02,960 --> 00:31:05,119 take a bunch of fiber every morning or he doesn't 591 00:31:05,160 --> 00:31:07,839 feel right during the rest of the day. And I've 592 00:31:08,119 --> 00:31:11,279 a long grappled with like how much of that is 593 00:31:11,319 --> 00:31:14,240 a narrative? How much of that is you trying to 594 00:31:14,279 --> 00:31:17,000 make sense of something that's hard to make sense of, 595 00:31:17,359 --> 00:31:21,240 And how much of that is treatable you know, is 596 00:31:21,279 --> 00:31:23,039 diagnosable and treatable. 597 00:31:23,119 --> 00:31:27,240 Speaker 4: You That is a classic story. And actually it's nice 598 00:31:27,279 --> 00:31:30,759 when somebody can even identify the trigger. Sometimes we don't 599 00:31:30,799 --> 00:31:33,599 know what the cause is, it can, but we do 600 00:31:33,720 --> 00:31:37,359 know that early childhood trauma, and I'm talking about emotional 601 00:31:37,400 --> 00:31:40,720 trauma or physical trauma like of an illness or stress, 602 00:31:41,720 --> 00:31:44,279 this can do it. But now picture that, whatever the 603 00:31:44,319 --> 00:31:49,079 trigger is, you've been living with this hyper sensitive gut 604 00:31:49,119 --> 00:31:53,599 that is perceiving pain multiple times a day, which nobody 605 00:31:53,640 --> 00:31:58,799 else perceives. And over time, very naturally a consequence of 606 00:31:58,839 --> 00:32:01,839 that is that you're going to become hyper vigilant. You're 607 00:32:01,880 --> 00:32:04,960 going to be wondering and worrying when is this next 608 00:32:05,400 --> 00:32:08,480 pain signal going to come? Could I even eat this food? 609 00:32:08,559 --> 00:32:10,839 Or is it going to send me into a pool? 610 00:32:10,880 --> 00:32:15,279 And you're worried about it quite understandably, And the more. 611 00:32:15,240 --> 00:32:18,960 Speaker 1: It turns into behaviors that are really problematic, like it 612 00:32:19,000 --> 00:32:22,440 turns into sometimes not just avoidance and restriction with food, 613 00:32:22,440 --> 00:32:26,759 which can cause nutritional deficits and downstream psychiatric problems, but 614 00:32:26,880 --> 00:32:30,119 also oh wait in the car, I'll be right there, No, 615 00:32:30,240 --> 00:32:31,920 I promise, I'm coming. I just need to try and 616 00:32:31,920 --> 00:32:34,359 go to the bathroom before we go. Like just a 617 00:32:34,400 --> 00:32:39,200 lot of fear around leaving and coming and going and 618 00:32:39,240 --> 00:32:43,079 resistance which can be really disruptive to know the flow 619 00:32:43,119 --> 00:32:44,599 of a family for example. 620 00:32:44,759 --> 00:32:47,920 Speaker 4: Oh my gosh, I'm so glad that you said that, because, yeah, 621 00:32:47,920 --> 00:32:51,359 the social consequences are really devastating and isolating. It's like 622 00:32:51,400 --> 00:32:53,640 you said, people just say, you know what, I'm going 623 00:32:53,680 --> 00:32:55,680 to cancel these brunch plans. I'm not going to take 624 00:32:55,720 --> 00:32:57,960 my dog for a walk because I don't know what 625 00:32:57,960 --> 00:33:00,000 the bathroom situation is going to look like five minutes 626 00:33:00,079 --> 00:33:00,880 from now. 627 00:33:00,960 --> 00:33:01,680 Speaker 3: Wherever we are. 628 00:33:01,720 --> 00:33:06,759 Speaker 4: And it is really isolating, it's embarrassing, and it's not 629 00:33:06,799 --> 00:33:10,000 a surprise to me that in irritable bowl syndrome there 630 00:33:10,039 --> 00:33:12,599 are high rates of anxiety and depression. 631 00:33:12,799 --> 00:33:15,960 Speaker 3: But if you take a step back, there are high rates. 632 00:33:15,759 --> 00:33:20,079 Speaker 4: Comparably high rates in so many other chronic illnesses, like 633 00:33:20,200 --> 00:33:23,440 lumatoid arthritis, for example, for which we think we have 634 00:33:23,480 --> 00:33:25,839 a very good understanding of the path of physiology. But 635 00:33:26,400 --> 00:33:28,240 in irritable bowl syndrome, when someone has a lot of 636 00:33:28,240 --> 00:33:31,519 anxiety and depression, we often put a lot more blame 637 00:33:31,599 --> 00:33:34,640 on the anxiety and depression as the cause rather than 638 00:33:35,240 --> 00:33:38,359 as a consequence. And it's like I said, it's really 639 00:33:38,519 --> 00:33:41,519 in some cases neither. It's just part of a vicious loop, 640 00:33:41,599 --> 00:33:46,319 and many of my patients, if they're not already on 641 00:33:46,440 --> 00:33:50,559 an anti anxiety or anti depressive medicine, I usually encourage 642 00:33:50,599 --> 00:33:54,640 it because we need to think about treating the central 643 00:33:54,680 --> 00:33:57,680 nervous system and the enteric nervous system together. It's very 644 00:33:57,680 --> 00:33:59,960 difficult to just say we're going to just treat the brain. 645 00:34:00,119 --> 00:34:01,960 We're just going to treat the gut, and that's going 646 00:34:02,039 --> 00:34:04,319 to fully stop it. You need to stop the signals 647 00:34:04,480 --> 00:34:06,200 everywhere you can. And in fact, a lot of the 648 00:34:06,200 --> 00:34:11,159 therapies that we give people in IBS we're originally designed 649 00:34:11,159 --> 00:34:15,159 as antidepressants. Like you you know, you might tricyclic. Antidepressants 650 00:34:15,519 --> 00:34:18,000 are a very common therapy, and IBS they do not 651 00:34:18,239 --> 00:34:22,079 do a fantastic job treating your depression. They work weekly 652 00:34:22,199 --> 00:34:25,239 to treat depression, but they're not anyone's first line usually 653 00:34:25,639 --> 00:34:25,960 for that. 654 00:34:26,039 --> 00:34:26,719 Speaker 2: But they do a. 655 00:34:26,639 --> 00:34:30,360 Speaker 4: Fantastic job of rewiring the nerves and the gut to 656 00:34:30,480 --> 00:34:33,559 just raise that threshold at which they fire and signal 657 00:34:33,639 --> 00:34:34,559 pain up to the brain. 658 00:34:35,159 --> 00:34:37,719 Speaker 1: Well, that's fascinating, and there are of course so many 659 00:34:39,280 --> 00:34:46,119 non I guess medical therapeutic approaches that you know are ancillary, 660 00:34:46,239 --> 00:34:49,079 like they're adjunctive. I would never say, have therapy to 661 00:34:49,119 --> 00:34:53,039 fix your ibs. But when we talk about the depression 662 00:34:53,039 --> 00:34:54,719 and the anxiety and really just a lot of like 663 00:34:54,760 --> 00:34:59,480 the behavioral restrictions that can sort of border line. Yes 664 00:34:59,519 --> 00:35:03,119 they're like anxiety functions, but they can borderline on some developed, 665 00:35:03,199 --> 00:35:08,360 sort of obsessive, compulsive types of behaviors. There's just so 666 00:35:08,559 --> 00:35:14,760 much that we can do with behavior change to improve 667 00:35:14,960 --> 00:35:19,039 the quality of somebody's life. And I almost wish that 668 00:35:19,159 --> 00:35:23,239 we had more like psychologists embedded in GI clinics for that. 669 00:35:23,440 --> 00:35:26,679 Speaker 4: Oh my gosh, we have we have two really want 670 00:35:27,199 --> 00:35:27,559 and I. 671 00:35:27,480 --> 00:35:29,280 Speaker 3: Think that, yeah, there's no way. 672 00:35:30,039 --> 00:35:32,360 Speaker 4: I mean, I think there's no way our center could 673 00:35:32,400 --> 00:35:36,159 run if we weren't multidisciplinary. And like they offer CBT 674 00:35:36,440 --> 00:35:39,840 all the time, they do cut hypnotherapy, and these are 675 00:35:39,880 --> 00:35:43,000 things that I think are critical to the care of 676 00:35:43,079 --> 00:35:46,719 a patient. But if you just say what you need 677 00:35:46,760 --> 00:35:49,480 is CBT without giving people a little bit of this 678 00:35:49,559 --> 00:35:52,760 background about the cycle and how this is a two 679 00:35:52,800 --> 00:35:55,760 way street between the brain and the gut, sometimes that'll 680 00:35:55,800 --> 00:35:58,519 be perceived is, oh, you're telling me, like what I 681 00:35:58,559 --> 00:36:01,519 need is therapy, and and I, yes, I am telling 682 00:36:01,559 --> 00:36:04,800 you that therapy will help you. But not because I'm 683 00:36:04,840 --> 00:36:08,679 dismissing the reality of your symptoms. So the context and 684 00:36:08,760 --> 00:36:11,599 just putting it in perspective will make all the difference. 685 00:36:11,639 --> 00:36:14,599 Because even when I bring up these tricyclic antidepressants and 686 00:36:14,639 --> 00:36:16,880 I don't give enough of a background about the why, 687 00:36:16,960 --> 00:36:19,719 people will hear you're telling me I need an anti 688 00:36:19,760 --> 00:36:22,599 depression medicine because you think this is only depression and. 689 00:36:22,559 --> 00:36:23,000 Speaker 3: It's not true. 690 00:36:23,119 --> 00:36:24,840 Speaker 4: And on the flip side, I also tell people, like, 691 00:36:25,559 --> 00:36:29,119 separately from your gut symptoms, we have to treat your anxiety, 692 00:36:29,199 --> 00:36:31,320 like we need to take this, you know, anti anxiety 693 00:36:31,320 --> 00:36:33,480 medicine if that's what's the right choice for you, because 694 00:36:34,000 --> 00:36:37,079 why would we not. We would never withhold an anti 695 00:36:37,079 --> 00:36:40,239 depression medicine, an anti anxiety medicine for any other condition. 696 00:36:40,960 --> 00:36:42,960 You know that where it's just it's part of the 697 00:36:43,159 --> 00:36:45,760 it's part of your overall well being. So you really 698 00:36:45,800 --> 00:36:48,239 need to think about both sides of it, and and 699 00:36:48,320 --> 00:36:51,440 I do all the time. And it's but you know, 700 00:36:51,519 --> 00:36:53,239 like you go on social media, this is not the 701 00:36:53,239 --> 00:36:56,239 conversation that you can convey in sixty seconds in a 702 00:36:56,280 --> 00:36:59,239 real What you can convey is like, try this abdominal 703 00:36:59,280 --> 00:37:02,519 massage and show you how to do it, and like, Okay, 704 00:37:02,559 --> 00:37:06,639 there's like very weak but not zero evidence for abdominal 705 00:37:06,679 --> 00:37:09,599 massage for constipation. I feel pretty meh about it, but 706 00:37:10,280 --> 00:37:12,920 like that's not what our whole conversation about IBS should 707 00:37:12,920 --> 00:37:13,320 ever be. 708 00:37:14,320 --> 00:37:15,119 Speaker 2: Right, right. 709 00:37:15,239 --> 00:37:18,199 Speaker 1: I mean, I think it's so important the point that 710 00:37:18,239 --> 00:37:21,920 you made that it bears repeating that sometimes these nuanced 711 00:37:21,960 --> 00:37:28,639 discussions that occur in clinical settings when they when we 712 00:37:28,679 --> 00:37:31,880 as practitioners aren't careful with our language, when we don't 713 00:37:31,880 --> 00:37:35,760 have the training, and when we're not conferring with you know, 714 00:37:35,800 --> 00:37:39,239 a multidisciplinary team, but the patient can hear is. 715 00:37:39,800 --> 00:37:46,480 Speaker 2: It's all in your head? And that is so invalidating. Yeah, 716 00:37:46,559 --> 00:37:47,840 it's not all in your head. 717 00:37:48,039 --> 00:37:51,239 Speaker 1: It's all of the above, and you can't tease any 718 00:37:51,280 --> 00:37:53,840 of this stuff apart. And I think that's I wish 719 00:37:53,920 --> 00:37:56,960 that we could start working towards that being a part 720 00:37:57,000 --> 00:38:00,119 of our social vocabulary, is that your mental health and 721 00:38:00,159 --> 00:38:03,960 your physical health are one in the same, like they Yes, 722 00:38:04,159 --> 00:38:06,000 it's the one you cannot them apart. 723 00:38:06,840 --> 00:38:08,960 Speaker 4: I mean, one way I think about it is I 724 00:38:09,079 --> 00:38:12,559 explain people how to people how pain signaling works right 725 00:38:12,639 --> 00:38:16,360 from your body, Like there is a neuron a nerve 726 00:38:16,440 --> 00:38:19,639 cell in your gut that is reacting to some trigger. 727 00:38:19,719 --> 00:38:21,760 And whether that trigger is something in your food, or 728 00:38:21,800 --> 00:38:25,599 it's an infection, or it's distension, it's something. And that 729 00:38:25,719 --> 00:38:29,000 trigger then acts on the nerve selling your gut, which 730 00:38:29,039 --> 00:38:31,440 then sends another signal to a nerve selling your spinal cord, 731 00:38:31,440 --> 00:38:33,760 and it sends another signal up to your brain. And 732 00:38:33,760 --> 00:38:35,639 then there's these different parts of the brain that react, 733 00:38:35,639 --> 00:38:38,519 and maybe they cause nausea, maybe they cause this pain. 734 00:38:38,559 --> 00:38:44,639 But our medicines can treat any point in that signaling pathway. 735 00:38:44,719 --> 00:38:48,119 Some of the medicines will treat primarily the nerve cells 736 00:38:48,159 --> 00:38:50,159 in the gut. Some are going to treat the brain. 737 00:38:50,199 --> 00:38:53,599 But it's important to remember pain only exists if your 738 00:38:53,639 --> 00:38:56,800 brain decides that it's there, you know. And so like 739 00:38:56,920 --> 00:39:01,440 some of our medicines that primarily treat the brain, it's again, 740 00:39:01,599 --> 00:39:03,440 it's not because we're saying it's all in your head. 741 00:39:03,440 --> 00:39:07,000 It's because that is the final pathway and pain perception, 742 00:39:07,159 --> 00:39:09,960 and that can be a powerful way to help you 743 00:39:10,000 --> 00:39:13,360 feel better, even if we're not necessarily directly targeting that. 744 00:39:13,480 --> 00:39:16,039 And I have lots of patients who I've referred to 745 00:39:16,079 --> 00:39:19,119 my excellent colleagues in GI psychology who work with me, 746 00:39:19,480 --> 00:39:22,480 and they'll say, like, you know, we've tried all these medicines. 747 00:39:22,559 --> 00:39:25,000 It was the cognitive behavioral therapy that moved the needle 748 00:39:25,039 --> 00:39:26,679 for me, like for the first time, it was a 749 00:39:26,679 --> 00:39:29,639 gut hypnotherapy. It was something that I couldn't offer with 750 00:39:29,719 --> 00:39:32,159 a treatment that targeted the gut. But they would have 751 00:39:32,239 --> 00:39:35,480 never been even open to trying those things had we 752 00:39:35,519 --> 00:39:38,639 not explained the physiology of how our bodies work. 753 00:39:39,519 --> 00:39:42,480 Speaker 1: You know, what's really like what you're bringing me to 754 00:39:42,920 --> 00:39:47,400 an important I think growth edge for myself right now, 755 00:39:47,480 --> 00:39:51,440 where on the one hand, you're validating something that I've 756 00:39:51,480 --> 00:39:54,119 long thought was like a personal thing that I want 757 00:39:54,159 --> 00:39:57,239 to bring up in a second. And but on the 758 00:39:57,280 --> 00:40:01,360 other hand, you know, as a psychologist, like I should 759 00:40:01,400 --> 00:40:05,400 know better, but I think you are reinforcing to me 760 00:40:06,039 --> 00:40:12,079 that the perception and the experience, you know, the phenomenology 761 00:40:12,159 --> 00:40:17,840 of the individual who has these just you know, horrific 762 00:40:19,360 --> 00:40:25,599 gut problems is these they are getting actual signals in 763 00:40:25,679 --> 00:40:30,039 their brain that are telling them panic. You're very sick 764 00:40:30,119 --> 00:40:34,000 right now, something is very wrong you. You can't leave 765 00:40:34,039 --> 00:40:36,400 the house right now. It could be disastrous for you. 766 00:40:36,599 --> 00:40:39,679 Or whatever the case may be. When I think we 767 00:40:39,719 --> 00:40:44,280 struggle sometimes because we're all very you know, golden rule, 768 00:40:45,039 --> 00:40:48,000 and you know, a big part of our job is 769 00:40:48,039 --> 00:40:51,480 to take the frame of another individual. And I think 770 00:40:51,519 --> 00:40:54,599 one of the things that I've struggled with personally, less 771 00:40:54,639 --> 00:40:58,400 so professionally, but personally is that I think I probably 772 00:40:58,960 --> 00:41:02,639 have the opposite I probably have very dull signals to 773 00:41:02,719 --> 00:41:04,599 my brain. And so when I have to go to 774 00:41:04,639 --> 00:41:06,239 the bathroom, I'm like, oh, there it is, gotta go 775 00:41:06,239 --> 00:41:07,599 to the bathroom. I'll be right back, and then I 776 00:41:07,639 --> 00:41:09,639 go and I'm done, and the rest of the time 777 00:41:09,679 --> 00:41:12,039 I don't think about it. And sometimes my guts are 778 00:41:12,039 --> 00:41:13,480 a little angry, and I'm like, oh, I think my 779 00:41:13,760 --> 00:41:14,719 guts are a little angry. 780 00:41:14,840 --> 00:41:15,400 Speaker 2: Huh. 781 00:41:15,440 --> 00:41:18,480 Speaker 1: And then I just get past it. And it's very rare. 782 00:41:18,519 --> 00:41:20,960 When people say, oh, I was so bloated yesterday, my 783 00:41:21,119 --> 00:41:23,719 common reaction will be, I don't know what that means. 784 00:41:24,360 --> 00:41:25,920 Speaker 2: Yeah, I've never felt that. 785 00:41:26,159 --> 00:41:28,280 Speaker 1: I know what it feels like to have eaten too much, 786 00:41:29,000 --> 00:41:31,800 but I've never been like, I'm having a really blowdy day, 787 00:41:31,840 --> 00:41:35,360 Like I physically could not describe that to you. So 788 00:41:35,480 --> 00:41:39,639 it's hard for me to empathize with an individual who's like, oh, 789 00:41:39,679 --> 00:41:42,119 I just feel off, like my guts feel slugged. 790 00:41:42,199 --> 00:41:45,639 Speaker 2: I'm like, what are you talking about? Your guts are gutting. 791 00:41:46,360 --> 00:41:47,480 Let's just get to. 792 00:41:49,519 --> 00:41:52,920 Speaker 4: Yeah, it's I don't think you're you're alone. I mean 793 00:41:52,960 --> 00:41:56,800 I think that this is a big It's. 794 00:41:56,639 --> 00:41:59,079 Speaker 3: Why being a doctor is so difficult. 795 00:41:59,320 --> 00:42:03,079 Speaker 4: Is I think we or any kind of clinician in 796 00:42:03,119 --> 00:42:05,880 your shoes, in anyone who has to care for people 797 00:42:05,880 --> 00:42:10,480 who have diseases that we don't ourselves necessarily have. It's 798 00:42:10,480 --> 00:42:13,480 hard to imagine. And I think something that strikes me 799 00:42:13,599 --> 00:42:16,920 often and helps ground me is that, actually, almost like 800 00:42:16,920 --> 00:42:19,480 what you were saying about what occurred to your acquaintance 801 00:42:19,519 --> 00:42:22,679 is that so many of my patients will say I 802 00:42:22,840 --> 00:42:25,639 was exactly like you. I was high functioning, I had 803 00:42:25,679 --> 00:42:29,119 a gut of steel. Then one day this thing happened. 804 00:42:29,119 --> 00:42:32,360 I got sick on a cruise and or I got 805 00:42:32,480 --> 00:42:35,079 you know, I ate some weird takeout and nothing has 806 00:42:35,119 --> 00:42:38,199 been the same since. And you meet them and you're like, 807 00:42:38,239 --> 00:42:40,760 you know, this could be met this could have happened 808 00:42:40,760 --> 00:42:43,039 to me, you know, but it just for whatever, like 809 00:42:43,239 --> 00:42:46,480 for whatever reason, luck like it didn't happen but it's 810 00:42:46,519 --> 00:42:49,119 not that you were necessarily was, And afferently there are 811 00:42:49,119 --> 00:42:51,559 patients who have been dealing with this since childhood too, 812 00:42:51,679 --> 00:42:53,800 But it's really just the luck of the draw. And 813 00:42:53,880 --> 00:42:58,519 it's not until I think I got really really nauseated 814 00:42:58,599 --> 00:43:02,239 during my pregnancies, and that was and I thought I 815 00:43:02,320 --> 00:43:05,239 considered myself very empathetic to my patients. I deal with 816 00:43:05,239 --> 00:43:07,840 not all the time in my practice with patients. 817 00:43:07,880 --> 00:43:08,960 Speaker 3: But it wasn't. 818 00:43:08,840 --> 00:43:12,559 Speaker 4: Until I got really sick that I just was so 819 00:43:12,679 --> 00:43:16,199 able to internalize how miserable that is. Like, however miserable 820 00:43:16,280 --> 00:43:19,440 I thought it was because I flattered myself I'm so empathetic. 821 00:43:19,800 --> 00:43:23,119 I couldn't until I felt it and lived it, you know. 822 00:43:23,159 --> 00:43:25,559 And so like it's for good reason that like in 823 00:43:25,599 --> 00:43:28,480 our practice sometimes we tell like a lot of the 824 00:43:28,480 --> 00:43:31,280 procedures and tests we tell patients to undergo when we're 825 00:43:31,320 --> 00:43:33,480 in training as g fellows, we do them to ourselves 826 00:43:33,519 --> 00:43:35,239 just so that we know exactly what it is that 827 00:43:35,280 --> 00:43:36,960 we're telling patients, like, oh, this is no big deal. 828 00:43:37,000 --> 00:43:39,039 We're just gonna put a little probe through your nose, 829 00:43:39,159 --> 00:43:41,280 or we'll do the battle prep for your cakelnosophy, like 830 00:43:41,280 --> 00:43:43,519 we do it so that we can live it and. 831 00:43:43,880 --> 00:43:44,440 Speaker 3: Share it back. 832 00:43:44,480 --> 00:43:48,760 Speaker 4: But it's empathy is a really hard like I'm still learning. 833 00:43:48,800 --> 00:43:52,320 It's not it we have easy skill, always practice, and 834 00:43:52,440 --> 00:43:54,519 it is not. I often will say, you're right, it's 835 00:43:54,519 --> 00:43:57,920 a skill. It's not like a talent. It's something you 836 00:43:58,000 --> 00:44:02,119 have to practice all the time. And I think, you know, 837 00:44:02,239 --> 00:44:05,320 another layer just came up that you mentioned, and I 838 00:44:05,320 --> 00:44:09,119 can't help but see a parallel with something that a 839 00:44:09,119 --> 00:44:12,079 lot of my listeners are familiar with because several years ago, 840 00:44:13,639 --> 00:44:16,199 so I work in a cancer center, so it was 841 00:44:17,079 --> 00:44:18,760 I don't work in a cancer center. 842 00:44:18,679 --> 00:44:19,840 Speaker 2: Because of this. 843 00:44:19,840 --> 00:44:22,559 Speaker 1: This happened while I was working in a cancer center, 844 00:44:22,760 --> 00:44:25,920 but I was one of the unlucky few for whom 845 00:44:26,639 --> 00:44:30,599 HPV turned into add no carcinoma in situ, and luckily 846 00:44:30,639 --> 00:44:32,760 we caught it early. Luckily I was able to have 847 00:44:32,760 --> 00:44:36,400 a hysterectomy remove any of the traces. You know, my 848 00:44:36,880 --> 00:44:39,000 chance of a recurrence is very, very low because it 849 00:44:39,000 --> 00:44:41,280 hadn't invaded the basement member and you know, some people 850 00:44:41,280 --> 00:44:43,920 call it like cancer stage zero, all these things. But 851 00:44:44,000 --> 00:44:46,880 one of the things I remember thinking at the time, 852 00:44:47,320 --> 00:44:49,400 and it just reinforces what I often say to my 853 00:44:49,440 --> 00:44:54,960 patients anyway, Is that like you did not ask for this, Like, yes. 854 00:44:54,800 --> 00:44:55,760 Speaker 2: I had HPV. 855 00:44:55,960 --> 00:44:59,039 Speaker 1: Okay, people could talk about lifestyle or not, like I 856 00:44:59,599 --> 00:45:03,440 not exactly. I was pre vaccine, so let's be you know, 857 00:45:03,559 --> 00:45:05,960 let's be honest. We did not have the protections that 858 00:45:06,000 --> 00:45:09,559 we have now. But ultimately, it is a luck of 859 00:45:09,599 --> 00:45:13,079 the draw if your body just clears the virus, which 860 00:45:13,159 --> 00:45:17,280 most people's uh do, or that it continues to mutate yourselves. 861 00:45:17,519 --> 00:45:20,280 It's the same thing with cancer, and it's the same 862 00:45:20,280 --> 00:45:23,480 thing with these gi issues. Like I've had NORO three times, 863 00:45:23,559 --> 00:45:27,119 I don't have any lasting problems from neurovirus. I can 864 00:45:27,360 --> 00:45:30,320 empathize with the pain of having neurovirons. 865 00:45:31,239 --> 00:45:33,280 Speaker 3: Yeah, I didn't wish that one on my enemy. 866 00:45:33,360 --> 00:45:36,440 Speaker 1: My no is the sickest I have ever been in 867 00:45:36,440 --> 00:45:40,559 my entire life. Luckily only for like two days. But yeah, 868 00:45:40,880 --> 00:45:44,000 it didn't stick with me. But you're right, it could 869 00:45:44,239 --> 00:45:47,280 just like you know, somebody's HPV could turn into cancer. 870 00:45:47,840 --> 00:45:51,920 Just like all of these things that we moralize as 871 00:45:51,960 --> 00:45:56,400 a culture have nothing to do with decision making. Want 872 00:45:56,440 --> 00:45:58,599 what did I do to deserve that deserve has nothing 873 00:45:58,639 --> 00:45:59,280 to do with it. 874 00:45:59,280 --> 00:45:59,960 Speaker 2: It just happened. 875 00:46:00,039 --> 00:46:02,960 Speaker 4: Yes, Yes, I'm so glad you said that, Yeah, because 876 00:46:02,960 --> 00:46:05,400 I mean I think sometimes when you make these diagnoses, 877 00:46:06,039 --> 00:46:09,679 that's the first thing people wonder is like, but why me, 878 00:46:09,960 --> 00:46:14,360 what did I do? And even in the GI scenarios, Yeah, 879 00:46:14,400 --> 00:46:17,719 sometimes we identify a cause. Usually it's a cause that 880 00:46:18,039 --> 00:46:20,840 you didn't control, Like, right, you didn't choose to eat 881 00:46:20,880 --> 00:46:22,920 the takeout that, like, I mean whatever, Like that's not 882 00:46:23,360 --> 00:46:26,320 that's something you could have prevented. But sometimes it's like, 883 00:46:26,400 --> 00:46:29,760 you know, maybe you had some genetic predisposition, like maybe 884 00:46:29,800 --> 00:46:33,159 you had some connective tissue disorder, maybe there was something 885 00:46:33,199 --> 00:46:35,719 in your childhood which obviously you didn't control. 886 00:46:35,760 --> 00:46:37,159 Speaker 3: Like we sometimes just. 887 00:46:37,320 --> 00:46:41,679 Speaker 4: Also just don't know, and it can be so frustrating 888 00:46:42,000 --> 00:46:44,880 to people. And then you couple that with the fact 889 00:46:44,960 --> 00:46:47,159 that this is this is specific to a lot of 890 00:46:47,159 --> 00:46:49,360 our GI problems, which is that a lot of your 891 00:46:49,400 --> 00:46:53,239 tests are normal. Like, you are miserable, you're suffering, you 892 00:46:53,320 --> 00:46:56,960 are really begging to get your doctor to empathize with 893 00:46:57,000 --> 00:46:59,800 you and help you. And what your doctor does sometimes 894 00:46:59,840 --> 00:47:03,480 is you know, like your colonoscopy is negative, your blood 895 00:47:03,480 --> 00:47:07,119 tests are negative, and that feels really invalidating. I mean, 896 00:47:07,119 --> 00:47:10,039 that is the how we define ibs is that these 897 00:47:10,039 --> 00:47:14,079 tests have to be quote normal, and then and then 898 00:47:14,079 --> 00:47:17,679 you really just feel like nobody gets me, nobody's believing 899 00:47:17,679 --> 00:47:19,119 in this, and then of course you turn to the 900 00:47:19,159 --> 00:47:22,360 online problem. But that's that's the issue in GI right now, 901 00:47:22,360 --> 00:47:23,559 which I think we're going to see a lot of 902 00:47:23,559 --> 00:47:25,360 transformation in the next ten years. It's not that the 903 00:47:25,400 --> 00:47:27,360 tests are normal, it's not that anyone's trying to gate 904 00:47:27,480 --> 00:47:31,519 keep the science. It's more that the types of abnormalities 905 00:47:31,519 --> 00:47:33,639 I'm talking about, like, for example, the threshold at which 906 00:47:33,639 --> 00:47:36,039 the nerves fire. Yeah, we can very elegantly show that 907 00:47:36,079 --> 00:47:39,320 in a research study where we take these full thickness 908 00:47:39,320 --> 00:47:42,159 biopsies out and we measure it, but it's not the 909 00:47:42,239 --> 00:47:43,960 kind of test you can just get at the bedside. 910 00:47:44,480 --> 00:47:46,440 And I think in the next ten years we're going 911 00:47:46,519 --> 00:47:48,320 to get those tests to the bedside and we're gonna 912 00:47:48,320 --> 00:47:51,079 be able to do that robustly. But in the meantime, 913 00:47:51,119 --> 00:47:53,840 there's there's lots of third parties will promise tests that 914 00:47:53,880 --> 00:47:55,000 do that right now, but they don't. 915 00:47:56,760 --> 00:47:58,480 Speaker 2: Yeah, and that's that's what's so dangerous. 916 00:47:58,480 --> 00:48:01,480 Speaker 1: When we're talking about you know, the cutting edge research, 917 00:48:01,679 --> 00:48:05,559 like the research that you do the opportunities that are 918 00:48:05,599 --> 00:48:09,000 available to patients, which you know, every day there are 919 00:48:09,039 --> 00:48:11,760 new therapies all of the time. I see this all 920 00:48:11,760 --> 00:48:13,719 the time right in a cancer center, Like I have 921 00:48:13,760 --> 00:48:16,679 patients who are failing out of you know, they're on 922 00:48:16,719 --> 00:48:18,880 third and fourth and fifth line treatments and there and 923 00:48:18,920 --> 00:48:20,639 by the time they fail out of their last one, 924 00:48:20,639 --> 00:48:20,960 there's like a. 925 00:48:20,960 --> 00:48:23,320 Speaker 2: Whole new drug on the market. They're like, oh, yeah, thanks, 926 00:48:23,400 --> 00:48:24,320 that's good timing. 927 00:48:25,159 --> 00:48:27,440 Speaker 1: And this happens a lot just because of the speed 928 00:48:27,480 --> 00:48:34,840 of innovation, but it can be frustrating when something seems 929 00:48:34,960 --> 00:48:37,760 like you said reasonable and maybe even the evidence is 930 00:48:37,800 --> 00:48:40,239 starting to point in that direction, and then like a 931 00:48:40,280 --> 00:48:43,199 Silicon Valley startup is like, don't worry, we figured it out. 932 00:48:43,280 --> 00:48:47,119 But yeah, you know, sometimes it's just Elizabeth Holmes right, 933 00:48:47,280 --> 00:48:49,599 like it's not real and I think we have to 934 00:48:49,599 --> 00:48:50,719 be careful about them. 935 00:48:51,239 --> 00:48:54,760 Speaker 4: And then you get some abnormality on some test, and 936 00:48:54,800 --> 00:48:56,639 then it's like, well, what do you do with that info? 937 00:48:56,760 --> 00:48:58,639 And usually what you do with that info is then 938 00:48:59,159 --> 00:49:03,440 you pay that company even more for their proprietary targeted 939 00:49:03,440 --> 00:49:06,519 supplement that will you know, suppose look at those addnirmalidies 940 00:49:06,679 --> 00:49:09,679 and you just you go down this expensive rabbit hole 941 00:49:09,800 --> 00:49:12,480 that that doesn't help people as much as it should. 942 00:49:13,159 --> 00:49:14,760 Speaker 2: Yeah, yeah, and you know. 943 00:49:14,840 --> 00:49:18,159 Speaker 1: Okay, So I have little experience with GI other than 944 00:49:18,280 --> 00:49:22,599 experience through working with patients, but more like personal experience 945 00:49:22,639 --> 00:49:24,480 of people in my life and people who I love 946 00:49:24,559 --> 00:49:28,119 having a lot of GI concerns. I want to ask 947 00:49:28,159 --> 00:49:30,880 you about something personal. And the reason I want to 948 00:49:30,880 --> 00:49:33,559 do it on the podcast is because it's a It's 949 00:49:33,559 --> 00:49:35,800 an experience that I know there will be people listening 950 00:49:35,880 --> 00:49:38,320 going okay, I'm dealing with the same thing. So thank 951 00:49:38,360 --> 00:49:39,559 you for bringing this out. 952 00:49:39,639 --> 00:49:41,360 Speaker 2: Lad. So I'm forty two. 953 00:49:42,800 --> 00:49:46,000 Speaker 1: I have never had any GI problems whatsoever, but I, 954 00:49:46,440 --> 00:49:50,440 for now quite some time, have had a history of 955 00:49:51,119 --> 00:49:58,480 low iron borderline iron deficiency, anemia right low ferretin, high 956 00:49:58,679 --> 00:50:05,199 binding capacity, oh like bound iron, but never like changes 957 00:50:05,280 --> 00:50:08,039 to my blood cells because of it. And then I've 958 00:50:08,039 --> 00:50:10,840 also just had like B twelve deficiency out the you know. 959 00:50:10,880 --> 00:50:13,639 So I'm constantly seeing my hematologists getting tested, and then 960 00:50:13,639 --> 00:50:15,079 about once a year I have to get an iron 961 00:50:15,119 --> 00:50:17,599 infusion maybe once every couple of years, I have to 962 00:50:17,599 --> 00:50:18,519 get B twelve shots. 963 00:50:18,719 --> 00:50:21,119 Speaker 2: Finally, she's like, you're going to GI. You're getting a 964 00:50:21,159 --> 00:50:22,880 colonoscopy and an endoscopy. 965 00:50:23,239 --> 00:50:25,079 Speaker 1: We've got to figure out because I don't have a period, 966 00:50:25,079 --> 00:50:28,079 because I don't have a uterus and I eat meat, 967 00:50:28,320 --> 00:50:31,920 so we're like, what is going on here. I've just 968 00:50:32,000 --> 00:50:35,360 spoken to my GI. She has told me about my prep. 969 00:50:35,519 --> 00:50:39,480 I am getting the tests on a book eighting congression. 970 00:50:39,480 --> 00:50:42,760 This will be my first time, so I'm hoping you 971 00:50:42,800 --> 00:50:45,760 can share with us. And she did share some really 972 00:50:45,760 --> 00:50:48,159 interesting things about all the new preps that are available. 973 00:50:48,159 --> 00:50:50,760 I'm planning on doing one where it's basically. 974 00:50:50,400 --> 00:50:52,679 Speaker 2: Just like a bunch of positive. 975 00:50:53,119 --> 00:50:54,400 Speaker 1: No. I don't want the pill one. I want the 976 00:50:54,480 --> 00:50:58,000 laxatives with the electrolyte drink. Oh yeah, yeah, yeah, yeah, 977 00:50:58,000 --> 00:50:59,719 that's my go to because I've had surgery. 978 00:50:59,800 --> 00:51:01,159 Speaker 2: I'm all about that. 979 00:51:01,159 --> 00:51:06,599 Speaker 1: That osmotical accidive and I love me some pedia a yeah. 980 00:51:06,639 --> 00:51:08,760 But she also was talking about how if we don't 981 00:51:08,760 --> 00:51:11,599 see anything, you know, She's like, all biopsy anything I see, 982 00:51:11,639 --> 00:51:13,719 I'll take samples, I'll look for h Pylorial'll do all 983 00:51:13,719 --> 00:51:16,079 this stuff. If I don't see anything, then you got 984 00:51:16,079 --> 00:51:18,280 to come back and swallow a camera because we're not 985 00:51:18,320 --> 00:51:21,480 going to reach your whole small intestin. So yeah, I'd 986 00:51:21,559 --> 00:51:25,079 love for you to help demystify in these last several minutes. 987 00:51:25,719 --> 00:51:29,400 What this so common test is that almost everybody has 988 00:51:29,400 --> 00:51:32,039 to undergo when they have GI issues. What it can 989 00:51:32,039 --> 00:51:34,199 tell us, what it can't tell us, what the experience 990 00:51:34,320 --> 00:51:37,239 is like, oh my, because it's a brave new world 991 00:51:37,719 --> 00:51:38,119 it is. 992 00:51:38,159 --> 00:51:40,239 Speaker 4: And I'm so happy you asked about this. This is 993 00:51:40,280 --> 00:51:42,760 like the perfect thing, and I talk about it. 994 00:51:43,480 --> 00:51:47,039 Speaker 2: She said, which like I didn't know I get propofall. 995 00:51:47,639 --> 00:51:50,079 This is amazing. I get to go full sleeps. 996 00:51:51,440 --> 00:51:53,559 Speaker 4: Well, you know, I will say that I think there's 997 00:51:53,599 --> 00:51:56,719 a lot of sometimes anxiety and dread about the kolonoscopy 998 00:51:56,840 --> 00:52:01,440 because people often hear about the klonosopy's experience from their 999 00:52:01,519 --> 00:52:04,280 dads or their moms. And I remind people like, this 1000 00:52:04,320 --> 00:52:07,960 is not your grandfather's prep. This is not your grandfather's kolonoscopy. Yes, 1001 00:52:08,039 --> 00:52:10,760 most of my patients, especially the ones who get propofol, 1002 00:52:11,119 --> 00:52:13,599 first of all, they wake up and they say when 1003 00:52:13,639 --> 00:52:16,000 are we getting started? And I'm like, hey, we did it. 1004 00:52:16,000 --> 00:52:16,440 Speaker 3: It happened. 1005 00:52:16,480 --> 00:52:19,039 Speaker 4: You're done, Like congrats, like it already happened. It was 1006 00:52:19,079 --> 00:52:22,079 over so fast, and they're like, I had the best 1007 00:52:22,199 --> 00:52:23,239 sleep of my life. 1008 00:52:23,280 --> 00:52:24,119 Speaker 2: That's what everybody says. 1009 00:52:24,159 --> 00:52:26,199 Speaker 1: It was like a really nice nap, right because we're 1010 00:52:26,239 --> 00:52:28,719 not using the well I shouldn't say we some places 1011 00:52:28,760 --> 00:52:33,119 probably still are. But the verse said fentanyl combo. That's 1012 00:52:33,199 --> 00:52:35,719 that's the WU that you see in all the TikTok videos. 1013 00:52:36,679 --> 00:52:38,440 Speaker 2: Yah, we use. 1014 00:52:38,360 --> 00:52:41,119 Speaker 4: Both, like we do some combination of like so it 1015 00:52:41,119 --> 00:52:42,840 depends on the patient and what they want. 1016 00:52:43,000 --> 00:52:44,960 Speaker 3: Like so we you know, like we do what you know, 1017 00:52:45,079 --> 00:52:46,000 all of them. 1018 00:52:46,239 --> 00:52:50,559 Speaker 4: But it's it's way easier, I think than it used 1019 00:52:50,559 --> 00:52:52,920 to be, like twenty thirty years ago. And part of 1020 00:52:52,960 --> 00:52:56,119 the reason it's easier now is because the prep can 1021 00:52:56,159 --> 00:52:57,880 be so much easier, Like there is a still a 1022 00:52:57,920 --> 00:52:59,719 world where you might be told, yeah, I still need 1023 00:52:59,760 --> 00:53:05,679 to this like huge like four liters of liquid, and 1024 00:53:05,719 --> 00:53:07,840 we can talk about like I have some great strategies 1025 00:53:07,840 --> 00:53:09,880 for how you can make that less miserable, which is 1026 00:53:10,079 --> 00:53:11,800 I will say, like the number one, two and three 1027 00:53:11,880 --> 00:53:14,920 thing is to put it on ice and drink it 1028 00:53:14,920 --> 00:53:17,480 through a straw. Like if you just do those things, 1029 00:53:17,519 --> 00:53:21,599 you'd be amazed at how quickly you're bypassing your olfactory system. 1030 00:53:22,039 --> 00:53:24,840 The ice like completely kills the taste and you can 1031 00:53:24,880 --> 00:53:26,320 just you can get rid of that. You can down 1032 00:53:26,360 --> 00:53:30,079 it pretty fast if you do that. But I also 1033 00:53:30,119 --> 00:53:33,079 tell people, okay, do the opposite, like warm it up, 1034 00:53:33,519 --> 00:53:36,960 mix that powdery prep into like a nice fu broth 1035 00:53:37,119 --> 00:53:39,159 or some of your like, like mix it in with 1036 00:53:39,199 --> 00:53:42,199 a ramen noodle packet and have it as a soup. 1037 00:53:42,239 --> 00:53:44,840 And that tastes great too, So you don't It doesn't 1038 00:53:44,840 --> 00:53:47,960 have to just be you sipping this like chalky, yucky 1039 00:53:48,400 --> 00:53:49,119 clear liquid. 1040 00:53:49,519 --> 00:53:50,480 Speaker 3: You can mix it into jell o. 1041 00:53:50,679 --> 00:53:53,880 Speaker 4: Jello is one of my favorite tips because even though 1042 00:53:53,920 --> 00:53:56,920 you are not supposed to have solids, Jello obviously like 1043 00:53:56,960 --> 00:53:59,360 turns immediately into like liquid as long as it's not 1044 00:53:59,400 --> 00:54:01,719 red jello. Nobody wants to You're not supposed to have 1045 00:54:01,760 --> 00:54:04,079 anything red or colored, but it can make it can 1046 00:54:04,079 --> 00:54:06,920 make the prep pretty easy. And for anyone who's on 1047 00:54:06,960 --> 00:54:09,079 the fence about like well why should I do a 1048 00:54:09,079 --> 00:54:11,440 colonoscopy when I can just do a stool kit, your 1049 00:54:11,480 --> 00:54:15,360 case is a little bit different because this is different 1050 00:54:15,360 --> 00:54:17,400 than a colon, like a colon cancer screening. 1051 00:54:17,840 --> 00:54:21,000 Speaker 2: Right, I'm for and this is just my normal time 1052 00:54:21,039 --> 00:54:21,639 to go get more. 1053 00:54:21,760 --> 00:54:24,639 Speaker 4: Yes, I have no symptoms, I have no any meadversity. 1054 00:54:24,719 --> 00:54:27,079 When you find differency. It makes sense to do what 1055 00:54:27,119 --> 00:54:29,639 you're doing and check for hi lory, make sure there's 1056 00:54:29,639 --> 00:54:30,840 not microscopic blood lass. 1057 00:54:30,840 --> 00:54:31,840 Speaker 3: So it's a little bit different. 1058 00:54:31,840 --> 00:54:34,800 Speaker 4: But otherwise I often get this question about, like why 1059 00:54:34,840 --> 00:54:36,800 the colonoscopy. It seems like it's a lot of work, 1060 00:54:36,840 --> 00:54:38,519 right because you have to if you're getting in athesia, 1061 00:54:38,880 --> 00:54:40,000 you kind of have to take the rest of the 1062 00:54:40,079 --> 00:54:42,480 day off. You're not supposed to drive. It's like, you know, 1063 00:54:42,559 --> 00:54:46,320 it's like a it's a somewhat big deal, although not insurmountable. 1064 00:54:46,519 --> 00:54:48,760 Speaker 3: Well, the reason is that the stool. 1065 00:54:48,400 --> 00:54:50,800 Speaker 4: Kits where you like poop in a box, you mail 1066 00:54:50,920 --> 00:54:55,000 that box back. It's like anonymous packaging. There's nothing embarrassing. 1067 00:54:54,519 --> 00:54:55,199 Speaker 2: About it at all. 1068 00:54:55,840 --> 00:54:59,880 Speaker 4: Very straightforward is that those toolkits are just detecting cancer. 1069 00:55:00,079 --> 00:55:03,079 And people need to remember that the colonoscopies are not 1070 00:55:03,440 --> 00:55:06,119 really there to detect cancer, like they do an excellent 1071 00:55:06,159 --> 00:55:10,199 job of that, but they're there to prevent cancer. Colonoscopies 1072 00:55:10,480 --> 00:55:14,360 it's like that HPV vaccine. It is doing something that 1073 00:55:15,239 --> 00:55:19,159 we have so few test modalities therapies and are in 1074 00:55:19,199 --> 00:55:21,519 our in all of medicine that will prevent cancer. And 1075 00:55:21,559 --> 00:55:23,880 this is one of them because we go in there 1076 00:55:23,920 --> 00:55:27,079 and we look for polyps. Polyps are these pre cancerous 1077 00:55:27,159 --> 00:55:30,320 growths that can become cancer, and we know about five 1078 00:55:30,360 --> 00:55:32,599 to ten percent of them will become cancer if we 1079 00:55:32,599 --> 00:55:35,440 do nothing about them. Well, we go in before that happens, 1080 00:55:35,480 --> 00:55:37,639 We take them out and we say, great, come back 1081 00:55:37,679 --> 00:55:39,519 and you know, seven to ten years, we'll see you 1082 00:55:39,519 --> 00:55:42,159 then and we've just wiped out the problem before it starts. 1083 00:55:42,159 --> 00:55:45,639 Whereas with a stool kit you may have polyps. You 1084 00:55:45,960 --> 00:55:48,440 you maybe have really gnarly polyps that are on the 1085 00:55:48,480 --> 00:55:51,679 pathway to become in cancer, but that stool kit test 1086 00:55:51,719 --> 00:55:54,199 will come back negative because they're not cancer, but they're growing. 1087 00:55:54,239 --> 00:55:55,960 They're there, and we're going. 1088 00:55:55,880 --> 00:55:59,119 Speaker 1: To just testing shedding cells at that point, like it's 1089 00:55:59,159 --> 00:56:02,920 testing your own own biology in your poop, which most 1090 00:56:02,960 --> 00:56:05,119 of your poop is not you, but there's some of 1091 00:56:05,159 --> 00:56:08,440 you in your poop that it's testing exactly. 1092 00:56:08,719 --> 00:56:09,880 Speaker 2: Okay. 1093 00:56:09,960 --> 00:56:12,280 Speaker 4: So that's my argument and my push to like, if 1094 00:56:12,320 --> 00:56:15,000 you're somebody who's doing this just for colon cancer screening, 1095 00:56:15,480 --> 00:56:17,760 always go for the colonoscope if you can, because it's 1096 00:56:17,800 --> 00:56:20,199 it's more than screening, it's it's prevent prevention. 1097 00:56:20,400 --> 00:56:22,639 Speaker 1: Yeah, and so when you when you do take the polyp, 1098 00:56:22,679 --> 00:56:25,559 like somebody, let's say somebody does have polyps. Okay, don't 1099 00:56:25,559 --> 00:56:28,840 freak out, like it's people get polyps. You you remove 1100 00:56:28,880 --> 00:56:32,079 the polyps, then you send them to pathology and you 1101 00:56:32,119 --> 00:56:35,920 actually look at whether or not they are pre cancers exactly. 1102 00:56:36,000 --> 00:56:38,360 Speaker 4: Yeah, and you're right, like, no reason to freak out. 1103 00:56:38,480 --> 00:56:40,519 Most of us, over the course of our lifetime will 1104 00:56:40,559 --> 00:56:43,960 develop polyps. Polyps happen for a lot of different reasons, 1105 00:56:43,960 --> 00:56:46,599 but usually the result of some form of inflammation. And 1106 00:56:46,719 --> 00:56:49,400 you know, for example, we know that different types of 1107 00:56:49,400 --> 00:56:51,920 foods do it right, Like processed meats will probably increase 1108 00:56:51,960 --> 00:56:54,480 you risk of polyps. Smoking of course increases your risk 1109 00:56:54,519 --> 00:56:56,800 of polyps. So but you know, even if you're like, well, 1110 00:56:56,840 --> 00:56:58,760 I'm I'm pretty healthy, I don do anything, you may 1111 00:56:58,800 --> 00:57:02,639 just be pretty genetically predisposed and you're gonna get pops. 1112 00:57:02,639 --> 00:57:05,480 So most of us get them, and five to ten 1113 00:57:05,519 --> 00:57:09,000 percent of them, so not all, but a notable percentage 1114 00:57:09,159 --> 00:57:11,360 go on to become cancer. So then we take them out. 1115 00:57:11,599 --> 00:57:13,800 They're small, you don't feel it at all, Like this 1116 00:57:13,960 --> 00:57:16,400 is like the easiest procedure in the world. We just 1117 00:57:16,480 --> 00:57:18,440 kind of grab them we pull them out, and then 1118 00:57:18,440 --> 00:57:20,199 we send them to our pathologists and they look at 1119 00:57:20,199 --> 00:57:23,119 them under the microscope and they say, basically, based on 1120 00:57:23,239 --> 00:57:25,719 how it looks under the microscope, whether it has features 1121 00:57:25,719 --> 00:57:28,280 that we would consider higher risk, like more on that 1122 00:57:28,320 --> 00:57:32,480 pathway getting closer and closer to a cancer type appearance, 1123 00:57:32,599 --> 00:57:35,199 and how many polyps you had, how big they were, 1124 00:57:35,480 --> 00:57:37,400 we make a decision about when you should come back 1125 00:57:37,400 --> 00:57:40,079 for your next screening Kladoski. So if you have nothing, 1126 00:57:40,199 --> 00:57:43,559 or maybe just one or two really tiny, safe looking ones, 1127 00:57:43,599 --> 00:57:46,000 we'll say come back in seven to ten years. But 1128 00:57:46,360 --> 00:57:48,719 if you have some kind of larger ones or ones 1129 00:57:48,719 --> 00:57:51,199 that have some concerning features under the microscope, we might 1130 00:57:51,199 --> 00:57:53,519 even say, hey, come back in one year, come back 1131 00:57:53,519 --> 00:57:56,480 in three years, just to make sure, because if you 1132 00:57:56,559 --> 00:57:58,400 have those types of polyps that seem to be a 1133 00:57:58,440 --> 00:58:01,360 little bit more concerning, it sort of means that you're 1134 00:58:01,400 --> 00:58:03,840 somebody who might grow polyps like you might just like 1135 00:58:03,920 --> 00:58:06,519 if we wait too long, another polyp might grow in 1136 00:58:06,559 --> 00:58:07,840 the meantime, and we don't want to miss it, so 1137 00:58:07,840 --> 00:58:09,360 that's why we tell you to come back sooner. 1138 00:58:09,480 --> 00:58:12,639 Speaker 1: Yeah, So this sounds like it's so similar for women 1139 00:58:12,679 --> 00:58:15,599 to a PAP test and to a colposcopy follow up, 1140 00:58:15,639 --> 00:58:17,639 and to you know, this is how I knew that 1141 00:58:17,679 --> 00:58:19,800 I because I had an abnormal PAP, because I had 1142 00:58:19,840 --> 00:58:24,840 abnormal glandular tissue, Like exactly, you catch it early, you 1143 00:58:24,920 --> 00:58:28,400 prevent the cancer from growing, and then you don't have 1144 00:58:28,480 --> 00:58:32,119 to get the chemo or the radiation or the invasive surgeries. 1145 00:58:33,039 --> 00:58:35,840 And so yeah, I mean, gosh, prevent you know whatever. 1146 00:58:36,039 --> 00:58:37,599 An ounce of prevention is worth a pound of cere. 1147 00:58:37,719 --> 00:58:41,119 Like we all know this, but in practice that's really important. 1148 00:58:41,159 --> 00:58:45,079 I got to ask before we continue this is is 1149 00:58:45,119 --> 00:58:47,320 there a world in which because if I only needed 1150 00:58:47,320 --> 00:58:49,800 a colonoscopy, I was going to ask if I could 1151 00:58:49,800 --> 00:58:53,159 do it without anesthesia, because I would prefer no anesthesia always. 1152 00:58:53,440 --> 00:58:55,840 Speaker 2: But I knew with an endoscopy that I. 1153 00:58:55,760 --> 00:59:00,920 Speaker 1: Did not want to even remotely have that conversation colonosteres. 1154 00:59:00,920 --> 00:59:03,119 Speaker 2: Are they painful or do they just feel weird? 1155 00:59:05,000 --> 00:59:05,880 Speaker 3: It's a good question. 1156 00:59:05,960 --> 00:59:09,840 Speaker 4: You know in other countries that it's actually normal to 1157 00:59:09,960 --> 00:59:14,760 not get sedation, I will say, and like sometimes when 1158 00:59:14,800 --> 00:59:17,840 me and my fellow physicians need to undergo our colonoscopies, 1159 00:59:17,840 --> 00:59:20,400 we often choose to not get sedation because we're so curious, 1160 00:59:20,440 --> 00:59:22,119 we want to like watch along really closely. 1161 00:59:22,239 --> 00:59:22,440 Speaker 1: Yeah. 1162 00:59:22,559 --> 00:59:26,159 Speaker 4: Yeah, so it's a choice you can make. But I 1163 00:59:26,239 --> 00:59:33,519 will say that people tend to want the sedation and 1164 00:59:33,719 --> 00:59:37,639 it's not you know, colonoscopies shouldn't be painful, but it 1165 00:59:37,760 --> 00:59:41,199 can be uncomfortable because one thing that causes the discomfort 1166 00:59:41,400 --> 00:59:44,079 is that in order to get a good look, we're 1167 00:59:44,119 --> 00:59:47,960 puffing up usually carbon dioxide, Like we put in a 1168 00:59:47,960 --> 00:59:50,760 little bit of air CO two to puff up your 1169 00:59:50,760 --> 00:59:53,000 colon so we can look in all the nooks and crannies. 1170 00:59:53,039 --> 00:59:56,880 But one of the most uncomfortable sensations to human beings 1171 00:59:56,880 --> 00:59:59,559 in real life is mechanical. 1172 00:59:59,039 --> 01:00:02,159 Speaker 2: Stretch to step yeah. 1173 01:00:01,360 --> 01:00:04,119 Speaker 4: Yeah, And so it's not like we're like causing harm 1174 01:00:04,159 --> 01:00:06,599 per se, but that is it can be perceived is 1175 01:00:06,679 --> 01:00:08,679 very very uncomfortable, and people don't like that. 1176 01:00:09,599 --> 01:00:13,480 Speaker 1: And so like it's like a laparoscopy where they just 1177 01:00:13,519 --> 01:00:15,639 like blow you up so they can do this surgery. 1178 01:00:15,880 --> 01:00:18,280 Speaker 4: Yeah yeah, but from within and then you know, your 1179 01:00:18,320 --> 01:00:20,599 body absorbs the YO two very quickly and it like 1180 01:00:20,719 --> 01:00:22,880 and or you'll pass all that gas as soon as 1181 01:00:22,880 --> 01:00:24,880 you wake up. So it's it's not like a long term, 1182 01:00:24,920 --> 01:00:26,599 it's not causing any long term issues at all. It's 1183 01:00:26,639 --> 01:00:29,880 just a little gas. But that's not like pleasant, I 1184 01:00:29,920 --> 01:00:32,239 will say, But but I do think like, yeah, you could, 1185 01:00:32,559 --> 01:00:34,880 you could do it without the station and and and 1186 01:00:34,920 --> 01:00:37,039 it could be like I've seen, I've I've done it 1187 01:00:37,079 --> 01:00:40,239 on patients of that station and it's totally fine. 1188 01:00:40,519 --> 01:00:41,760 Speaker 3: The upper endoscopy. 1189 01:00:42,000 --> 01:00:44,679 Speaker 4: I have seen once somebody come in and say I 1190 01:00:44,679 --> 01:00:46,960 absolutely don't want it, and we've powered through it, like 1191 01:00:47,000 --> 01:00:47,880 you just have to fight. 1192 01:00:48,400 --> 01:00:51,679 Speaker 1: Your dad did, like like a crazy person. He like 1193 01:00:52,199 --> 01:00:55,639 he did his colonoscopy once and was like under like 1194 01:00:55,719 --> 01:00:57,800 twilight and was like that wasn't so bad. I want 1195 01:00:57,800 --> 01:00:59,320 to just do it. And they were like, well, we 1196 01:00:59,360 --> 01:01:01,119 need to do an end too, and he was like, yeah, 1197 01:01:01,199 --> 01:01:01,960 let's just do both. 1198 01:01:02,000 --> 01:01:02,840 Speaker 2: And they were like are. 1199 01:01:02,760 --> 01:01:09,440 Speaker 1: You sure, and he goes that was a mistake, but yeah. 1200 01:01:08,440 --> 01:01:10,960 Speaker 4: Like unless there's a really good reason why, like you 1201 01:01:11,039 --> 01:01:14,559 have to be very it's more than willpower to overcome 1202 01:01:14,599 --> 01:01:17,360 that gag reflex. But when you even have just like 1203 01:01:17,400 --> 01:01:20,400 the twilight, which is the you know, the medaz or 1204 01:01:20,519 --> 01:01:23,000 fentonal combination, it goes down. 1205 01:01:23,119 --> 01:01:24,440 Speaker 3: The scope goes down very quickly. 1206 01:01:24,480 --> 01:01:26,119 Speaker 4: The gag reflex part of it is just a couple 1207 01:01:26,119 --> 01:01:28,360 of seconds, like it's very quick and then and then 1208 01:01:28,360 --> 01:01:33,000 it's it's all over. And frankly, yeah, I would take 1209 01:01:33,039 --> 01:01:35,800 if I've had an endoska people inspy, I took the 1210 01:01:35,800 --> 01:01:38,440 sedation like I I there's no reason, there's no reason 1211 01:01:38,519 --> 01:01:38,719 not to. 1212 01:01:38,920 --> 01:01:39,960 Speaker 3: I've seen I've. 1213 01:01:39,840 --> 01:01:42,119 Speaker 1: Been around kids when they have to get an ENNG. 1214 01:01:42,679 --> 01:01:44,000 I've been around you know, like. 1215 01:01:44,039 --> 01:01:46,360 Speaker 2: Oh yeah, it can be kind of traumatic. 1216 01:01:46,519 --> 01:01:50,800 Speaker 1: So you know, know thyself and know how you how you. 1217 01:01:50,760 --> 01:01:52,239 Speaker 2: React to your gag reflex. 1218 01:01:52,559 --> 01:01:55,159 Speaker 4: I honestly think that that is the best thing. Like 1219 01:01:55,199 --> 01:01:57,599 I think you know yourself, like you know, am I 1220 01:01:57,679 --> 01:02:02,679 somebody who has a high or low threshold for pain? Discomfortable? 1221 01:02:02,840 --> 01:02:06,320 And if you're like, you know what, I know myself. 1222 01:02:06,400 --> 01:02:09,760 I don't want to take that. It's like, don't don't 1223 01:02:09,960 --> 01:02:11,840 like try for the first time in your life to 1224 01:02:11,880 --> 01:02:15,320 do something risky on the day of your klenoscopy. Yes, 1225 01:02:15,960 --> 01:02:18,159 like you know, I like, make it easy on yourself, 1226 01:02:18,199 --> 01:02:20,239 make it easy on the team. And let's just like 1227 01:02:20,280 --> 01:02:21,960 we're here to screen you, you know, like we're just 1228 01:02:21,960 --> 01:02:24,480 trying to get rid of your polyps and get you 1229 01:02:24,559 --> 01:02:25,039 on your day. 1230 01:02:25,840 --> 01:02:28,039 Speaker 1: And so what about for folks like who are in 1231 01:02:28,119 --> 01:02:30,960 my shoes. Let's say nothing comes back. They don't see anything, 1232 01:02:31,000 --> 01:02:32,800 and they're like, we want to dig a little deeper. 1233 01:02:33,159 --> 01:02:35,519 There is a test where you have to swallow a 1234 01:02:35,639 --> 01:02:36,960 camera in the office. 1235 01:02:37,280 --> 01:02:39,280 Speaker 4: Yes, so this is I mean, this is kind of 1236 01:02:39,320 --> 01:02:44,360 an exciting relatively new kids called capsule endoscopy. So this 1237 01:02:44,480 --> 01:02:47,760 is something that we do often for cases where we 1238 01:02:48,239 --> 01:02:51,599 worry that there may be some source of microscopic bleeding 1239 01:02:51,639 --> 01:02:54,920 somewhere in the gut. But remember the colonoscopy. Your colon's 1240 01:02:54,960 --> 01:02:57,880 about a meter long, give or take, and it goes 1241 01:02:57,920 --> 01:03:00,159 all the way up. The scope can go all the 1242 01:03:00,199 --> 01:03:02,719 way up to the colon and usually just the first 1243 01:03:02,719 --> 01:03:05,920 couple of inches of the end of your small bell. 1244 01:03:06,639 --> 01:03:08,960 And when we do an upper endoscopy, it goes through 1245 01:03:08,960 --> 01:03:10,960 your esophagus, your stomach, and we get a nice good 1246 01:03:10,960 --> 01:03:12,559 look at the first part of your small bell. 1247 01:03:12,679 --> 01:03:15,039 Speaker 3: But that leaves feet. 1248 01:03:14,800 --> 01:03:17,000 Speaker 4: And feet of small bell that we haven't gotten a 1249 01:03:17,000 --> 01:03:18,960 good look at because the scopes are just not going 1250 01:03:19,000 --> 01:03:20,760 to be long enough to get to the middle portion 1251 01:03:20,840 --> 01:03:23,320 of your gut. That's where the capsule dscoy comes in. 1252 01:03:23,400 --> 01:03:25,519 You swallow this capsule that has a camera at the 1253 01:03:25,639 --> 01:03:28,320 end and it floats along through your stomach, through your 1254 01:03:28,320 --> 01:03:30,320 small bun, and it's taking a picture the whole time, 1255 01:03:30,320 --> 01:03:33,679 like a video which we then watch later sped up, 1256 01:03:33,760 --> 01:03:36,159 of course, because otherwise we've been there for forty eight hours. 1257 01:03:35,960 --> 01:03:36,480 Speaker 3: Looking at the screen. 1258 01:03:36,519 --> 01:03:37,800 Speaker 4: But we watch it sped up, and we have you know, 1259 01:03:37,840 --> 01:03:40,199 we can detect do we see a flash of red anywhere? 1260 01:03:40,239 --> 01:03:43,239 Do we see erosions? Any ulcers that we think could 1261 01:03:43,320 --> 01:03:45,920 be the cause polyps too? Sometimes we you know, rarely, 1262 01:03:45,960 --> 01:03:47,480 but we see them in the small val. 1263 01:03:47,599 --> 01:03:49,960 Speaker 3: So it's a great test. And then if we see. 1264 01:03:49,719 --> 01:03:53,119 Speaker 4: It, we can say, Okay, the exact location is probably 1265 01:03:53,119 --> 01:03:54,840 somewhere in this part of the small bowel. Then we 1266 01:03:54,880 --> 01:03:56,280 can think about what is the tool that we're going 1267 01:03:56,360 --> 01:03:58,079 to use to get to that exact part of the 1268 01:03:58,119 --> 01:03:59,119 bowl that we need to get to. 1269 01:03:59,559 --> 01:04:02,239 Speaker 1: Yeah, curious, how do you know where you are if 1270 01:04:02,239 --> 01:04:06,400 you're like on a on a voyage through the alimentary canal? 1271 01:04:06,559 --> 01:04:08,920 Like you know, how do you know like where you're 1272 01:04:09,039 --> 01:04:11,119 stopping to see that little flash of red? 1273 01:04:11,199 --> 01:04:11,920 Speaker 3: Oh you are? 1274 01:04:12,000 --> 01:04:16,400 Speaker 4: You're you're asking questions like a good gi fellow. And 1275 01:04:16,480 --> 01:04:18,400 the way we know is because we actually your body 1276 01:04:18,440 --> 01:04:23,159 has a couple of landmarks for one, and that can 1277 01:04:23,239 --> 01:04:25,159 kind of tell us, like give us clues about where 1278 01:04:25,159 --> 01:04:27,480 we are, Like when we start to we will know 1279 01:04:27,559 --> 01:04:30,199 when we look at the image whether the folds look 1280 01:04:30,280 --> 01:04:32,119 like your stomach, or whether the folds look more like 1281 01:04:32,119 --> 01:04:34,440 small ball, or whether they look like you're colon. And 1282 01:04:34,480 --> 01:04:37,519 then we also know kind of based on really how 1283 01:04:37,559 --> 01:04:41,639 long the capsule has been transitting, we can approximate how 1284 01:04:41,679 --> 01:04:43,840 long it should have taken to get through your small 1285 01:04:43,920 --> 01:04:46,119 valel and like, so we're never like, oh, yeah, you're 1286 01:04:46,320 --> 01:04:51,519 exactly like, you know, twelve feet in three inches, Like 1287 01:04:51,559 --> 01:04:53,039 it's never going to be that close, but we can 1288 01:04:53,079 --> 01:04:55,239 get a pretty good guess. 1289 01:04:55,039 --> 01:04:58,760 Speaker 1: It's just so fascinating, how you know, every day it 1290 01:04:58,800 --> 01:05:03,159 does feel like they're are new diagnostic tools, new therapies, 1291 01:05:03,639 --> 01:05:07,639 new information is coming out both at the individual level 1292 01:05:07,760 --> 01:05:09,440 and the population level. 1293 01:05:09,719 --> 01:05:10,960 Speaker 2: There's so much here. 1294 01:05:11,079 --> 01:05:13,480 Speaker 1: And I have to say I usually would never recommend 1295 01:05:13,559 --> 01:05:18,159 another book during the author interview for your book, but 1296 01:05:18,679 --> 01:05:20,400 I can imagine that you have read it. If you haven't, 1297 01:05:20,440 --> 01:05:23,800 you need to read a Gulp by Mary Roach. 1298 01:05:23,840 --> 01:05:26,320 Speaker 3: Oh, I've read it and I love it. She's amazing, 1299 01:05:26,400 --> 01:05:28,320 brilliant writer. That's a brilliant book. 1300 01:05:28,239 --> 01:05:30,599 Speaker 1: And so I feel like they go hand in hand, right, 1301 01:05:30,599 --> 01:05:33,719 because the one is her curiosity as a journalist and 1302 01:05:34,079 --> 01:05:37,159 in no way an expert interviewing experts and trying to 1303 01:05:37,199 --> 01:05:40,320 answer questions. And then you've got the other side of 1304 01:05:40,559 --> 01:05:43,760 the coin, which is an expert in so many different 1305 01:05:43,840 --> 01:05:49,639 aspects of the gut sharing. But in a way that 1306 01:05:49,880 --> 01:05:52,760 is comparable, I think to Mary's style, where it's like 1307 01:05:52,880 --> 01:05:56,840 really accessible, it's interesting, it's funny, you're not afraid to 1308 01:05:57,960 --> 01:06:01,599 just like use plain language, which is so incredibly important, demystify, 1309 01:06:01,920 --> 01:06:04,519 take the taboo away from pooping. 1310 01:06:04,880 --> 01:06:06,679 Speaker 2: We all do it, guys. It's like the Kid's book, 1311 01:06:06,719 --> 01:06:07,519 Everybody poops. 1312 01:06:08,480 --> 01:06:09,760 Speaker 1: You don't have to hide each other. 1313 01:06:10,760 --> 01:06:14,039 Speaker 3: There's no greater honor than to be compared to Mary Roach. 1314 01:06:14,079 --> 01:06:16,119 Speaker 4: And what I love about her is that, like she 1315 01:06:16,280 --> 01:06:19,599 has a just absolutely brilliant sense of humor, like that 1316 01:06:19,639 --> 01:06:22,280 comes through in like every single chapter, and so I 1317 01:06:22,320 --> 01:06:23,440 think that's also what makes it funny. 1318 01:06:23,480 --> 01:06:24,960 Speaker 3: And I think if you're gonna do gut healths. 1319 01:06:24,800 --> 01:06:26,559 Speaker 4: For a living like you, you kind of have to have 1320 01:06:26,599 --> 01:06:28,920 a sense of humor to engage people and like make 1321 01:06:28,960 --> 01:06:30,480 people want to want to stay glued. 1322 01:06:31,039 --> 01:06:33,480 Speaker 1: Absolutely, So I got to ask if there's, you know, 1323 01:06:34,239 --> 01:06:36,079 a big takeaway. There are a lot of takeaways here, 1324 01:06:36,199 --> 01:06:40,119 but let's say your average person listening to this podcast 1325 01:06:40,440 --> 01:06:44,039 is like, Okay, maybe they've had some gut issues and 1326 01:06:44,079 --> 01:06:46,079 they haven't really followed up with their doctor. 1327 01:06:46,480 --> 01:06:48,400 Speaker 2: Or maybe they're like em. 1328 01:06:48,559 --> 01:06:51,599 Speaker 1: Probably should have gotten that colonoscopy, probably didn't want to, 1329 01:06:51,920 --> 01:06:54,800 or maybe they are crippled in pain all the time, 1330 01:06:55,039 --> 01:06:58,239 they've not gotten the answers that they're looking for and 1331 01:06:58,239 --> 01:06:59,679 they've sort of given up hope. 1332 01:07:00,119 --> 01:07:03,800 Speaker 2: What would the advice be. 1333 01:07:03,079 --> 01:07:06,559 Speaker 1: For a listener of the show right now, a reader 1334 01:07:06,599 --> 01:07:09,119 of the book who's like, I need help and I'm 1335 01:07:09,239 --> 01:07:11,039 I'm kind of losing hope about that help. 1336 01:07:11,840 --> 01:07:16,360 Speaker 4: Yeah, to two things. One, I think the biggest advice 1337 01:07:16,440 --> 01:07:20,679 for everybody is to get help. And that sounds very simple, 1338 01:07:20,719 --> 01:07:23,480 but one in three people will avoid seeing their doctor 1339 01:07:23,519 --> 01:07:26,599 because they're so embarrassed about their bowel symptoms. So really 1340 01:07:27,199 --> 01:07:30,360 overcoming that stigma is the first step, and saying I'm 1341 01:07:30,360 --> 01:07:32,079 going to talk to my doctor about this. I'm not 1342 01:07:32,119 --> 01:07:35,519 going to just normalize or brush aside this bloating, this 1343 01:07:35,559 --> 01:07:37,679 discomfort that I live with because it's not a big 1344 01:07:37,800 --> 01:07:40,239 enough deal yet I don't want to embarrass myself. If 1345 01:07:40,280 --> 01:07:42,960 it's bothering, you get the help. And then the second 1346 01:07:42,960 --> 01:07:45,840 part of this is if you've done that, you've tried 1347 01:07:45,840 --> 01:07:48,039 to get help and you feel like my doctor isn't 1348 01:07:48,079 --> 01:07:51,280 listening to me or I'm not the treatment options just 1349 01:07:51,280 --> 01:07:54,320 don't seem to be getting anywhere. Ask your doctor if 1350 01:07:54,320 --> 01:07:58,159 they can refer you to a gastroentrologist one, and then 1351 01:07:58,280 --> 01:08:01,800 even beyond that, maybe you need a neuro gastrentrologist, which 1352 01:08:01,840 --> 01:08:05,239 is somebody who really subspecializes in in the gut brain connection. 1353 01:08:05,360 --> 01:08:08,320 And that's you know, we're the few the proud, but 1354 01:08:08,519 --> 01:08:12,039 we really do see the cases that are are hard 1355 01:08:12,360 --> 01:08:15,199 or to treat, and people should know that. Like, there's 1356 01:08:15,239 --> 01:08:17,359 a lot of data about how we can treat a 1357 01:08:17,359 --> 01:08:19,479 lot of these disorders, but sometimes you just need somebody 1358 01:08:19,520 --> 01:08:21,199 who's really well versed in the data. 1359 01:08:22,439 --> 01:08:22,800 Speaker 2: Yeah. 1360 01:08:23,239 --> 01:08:28,399 Speaker 1: Yeah, Oh, it's so important just to just to be 1361 01:08:28,479 --> 01:08:32,560 aware of that we can't we can't make decisions when 1362 01:08:32,560 --> 01:08:35,880 we don't have the information available to us. And so 1363 01:08:36,039 --> 01:08:40,960 it's important even to know that your specialty exists and 1364 01:08:41,000 --> 01:08:44,399 that if you're hitting a wall, there are still options 1365 01:08:44,479 --> 01:08:47,439 out there. Like, I hate it, but we have to 1366 01:08:47,479 --> 01:08:50,960 be our own best advocates in the healthcare system. Nobody's 1367 01:08:51,000 --> 01:08:53,560 going to take on that role for us. And so 1368 01:08:54,720 --> 01:08:58,920 you know here here like you deserve to be heard, 1369 01:08:59,439 --> 01:09:02,800 you deserve to get help. You do not have to 1370 01:09:03,399 --> 01:09:08,840 go through life suffering in silence. And also, I gotta say, 1371 01:09:08,920 --> 01:09:11,319 colon cancer is rising. We know this. We could talk 1372 01:09:11,359 --> 01:09:13,319 about the reasons for it, We could talk about all 1373 01:09:13,359 --> 01:09:17,279 of that, but like, get tested people, especially if you're 1374 01:09:17,399 --> 01:09:20,720 in that bracket where you should have already gotten your colonoscopy, 1375 01:09:20,800 --> 01:09:23,319 where you should be following up. And I would say 1376 01:09:23,359 --> 01:09:25,920 the same thing to young people. You know, get your 1377 01:09:25,960 --> 01:09:28,359 pap smear, do the things that you need to do, 1378 01:09:28,520 --> 01:09:33,560 get your mammogran women when you turn forty, Yes, prevention 1379 01:09:33,800 --> 01:09:36,319 is so much easier. I am a huge testament to that. 1380 01:09:37,000 --> 01:09:39,840 You know, I did have to have surgery. It was scary. 1381 01:09:40,039 --> 01:09:42,079 And at the same time, who is my life better 1382 01:09:42,079 --> 01:09:42,880 without a uterus? 1383 01:09:43,159 --> 01:09:44,920 Speaker 2: Right? It's like way better. 1384 01:09:45,439 --> 01:09:48,680 Speaker 1: And now I know I'm not gonna get cervical cancer 1385 01:09:48,720 --> 01:09:51,800 because I don't have a SERFX right, all of those 1386 01:09:51,840 --> 01:09:55,920 selves have been removed from my body and I'm you know, 1387 01:09:56,000 --> 01:09:58,319 my risk is just in the toilet now when it 1388 01:09:58,439 --> 01:10:00,399 was signal. I mean, it was almost a geary tea 1389 01:10:00,520 --> 01:10:03,840 that I would end up with invasive carsonoma before. So 1390 01:10:04,600 --> 01:10:07,840 that's that conversation we had about polyps. I think, you know, 1391 01:10:07,960 --> 01:10:11,319 as as important as the whole conversation has been and 1392 01:10:11,439 --> 01:10:15,399 I think validating and hopefully very personal for a lot 1393 01:10:15,399 --> 01:10:16,239 of listeners. 1394 01:10:16,840 --> 01:10:19,960 Speaker 2: There's also some real life saving advice and hear you guys, 1395 01:10:20,039 --> 01:10:20,840 so listen. 1396 01:10:20,640 --> 01:10:23,560 Speaker 1: Up and everybody, you should pick up the book. It's 1397 01:10:23,640 --> 01:10:26,319 it's out now. It's called You've Been Pooping All Wrong 1398 01:10:26,840 --> 01:10:30,640 How to Make your Bowel Movements a Joy by doctor 1399 01:10:30,800 --> 01:10:34,560 Tricia Pasricha. Thank you so so much for being here. 1400 01:10:35,000 --> 01:10:36,920 Speaker 3: Oh my gosh, this was such a pleasure. Thank you 1401 01:10:36,960 --> 01:10:37,479 for having me. 1402 01:10:38,000 --> 01:10:41,199 Speaker 1: Oh it was wonderful. And everybody listening, thank you for 1403 01:10:41,239 --> 01:10:44,199 coming back week after week. I'm really looking forward to 1404 01:10:44,279 --> 01:10:46,279 the next time we all get together to talk. 1405 01:10:46,399 --> 01:10:46,760 Speaker 2: Mardie