Hey, it's your friend Mel and welcome to the Mel Robbinspodcast.
The other day I read this crazy piece ofresearch.
Did you know that two thirds of people have a gutissue?
And you want to know the age group that is the mostaffected?
This one really surprisedme.
18 to 44 yearolds.Yep, it's not yourgrandparents.
It's 18 to 44 yearolds.73% of people in that age range have a gutissue.
So if you're feeling bloated or you're constipated or you have IBS or you're constantly popping the thumbs and you wish that you could do something about it or maybe somebody that you love has one of theseissues.
Well, I have booked you and me an appointment with the number one gut health medicaldoctor.
I think she's absolutelyamazing.
I'm talking 30 years of medical experience and she's here to just set the record straight with the medicalfacts.
She's going tosay, throw out your supplements in the probiotics because there are simple things that you cando.
Infact, you should do starting today to have a healthier gut to beat thebloat, settle your IBS and address constipation once and forall, which you will also learn may be caused by a very surprising issue in yourchildhood.
And you're also going to learn the extraordinary role that your gut health plays in yourimmunity,energy, mentalhealth, estrogen production and so muchmore.
This is a master class on your gut health and absolutely everyone that you know needs to hearit.
Hey, it's your buddyMal.
I am so glad you're here with metoday.
It is such an honor to be able to spend some time with youtoday.
And I want to acknowledge you for choosing to listen to something that can help you create a betterlife.
I think it is so awesome that you're taking time foryourself.
And I love spending that time withyou.
If you are a brand newlistener, welcome to the Mel Robbins podcastfamily.
I'm MelRobbins. I'm on a mission to inspire and empower you with tools and the expert resources that you deserve so that you can create a betterlife.
And I am thrilled to introduce you to a remarkable humanbeing.
Her name isDr. RobinChutkin.
She is a renowned gastroenterologist who is the founder of the Digestive Center forWellness, which is an integrative gastroenterology practice where for 20years,Dr.
Robin has been working with patients to help them uncover the root cause of GIdisorders.
She's been on the faculty of Georgetown Hospital for 27years.
Dr. Robin received her bachelor degree fromYale, her medical degree and residency atColumbia, where she was the chiefresident, which basically means she was the top doc in her residency at medicalschool.
And then she did a GI fellowship at Mount SinaiHospital.
Dr. Robin has also authored dozens of academic journal articles and bookchapters.
And she lectures frequently on the microbiome and gut health throughout the United States andEurope.
She's also the host of the Gut Blispodcast, the author of four best sellingbooks, the antiviralgut, gutblis, the microbiomesolution, and the gut bloatcure.
And you're going to loveher.
And so will everyone in yourfamily.
Soplease, if you got a friend or a loved one who's been complaining nonstop about their stomachissues, this is a mustshare.
So let's jump in and please help me welcomeDr.
Robin. I'm so excited to behere.
Thank you so much for havingme.
We're going to go all thingsgut, not just the obviousthings, but we're going to talk about gutbrain, gutimmune, how the gut is your engine for your entirebody.
It drives all theprocesses.
And I think we're going to really give people a new way of looking at the gut and how powerful itis.
Absolutely. And what I also love about your work is you take all this science and distill it down into simple things that I cando.
You listening are going to be able to walk out of here and know exactly what to do to take care of your health to make your gutbetter.
And you're going to understand why this matters somuch.
I'm so glad to behere. SoDr.
Robin, it does seem like everybody I know has a gutissue, like the bloating and theIBS.
Imean, are you finding that in your clinicalpractice?
Gut issues seem like they're on therise.
They're absolutely on therise.
And as agastroenterologist, youknow, I've always seen a lot of gutissues.
But if we looknationally, there was a study done last year by MDVIP and they found that two-thirds of Americans suffer from gutissues.
The highest number is in the 18 to 44 agegroup.
Why?73%. I think a lot of it has to do with the food that they'reeating.
They're eating more ultra-processed foods orbusy.
They're on thego. I think there's a lot of stress and that has a profound impact on thegut.
And I think they're also moreaware, which isgood,right?
Imean, it's good to be aware that this isn't functioningproperly.
But that's the highestpercentage.
And what theyfound, the American Gastroenterological Association did a survey and they found that40% ofAmericans, and this is across theboard, said that they had GI issues to the point where it was interfering withsocializing, with runningerrands, withexercising, with havingsex, withlibido.
Wow. And tome, the really frightening part of all of this is the AGA launched acampaign, a Ruckle Trust you got aroundthis.
One in three Americans do not feel comfortable talking to their doctor about gut issues and will only raise it if the doctorasks.
It'slike, don'task, don'ttell.
Because of embarrassment andhonestly, this was the reason when I read this lastyear, I waslike, ohno, I've got to do something aboutthis.
Like, I want people to be a medicaldetective.
Like, you turn around and take a look at thatpoo.
You tell me what it lookslike.
If you need to poke around in it with astick,understand, why do you havegas?
Why are youbloated? Why are you backedup?
We have to educate people aboutthis, how thisworks.
And the education that I see out there is mostly thebiohacking, take thissupplement,do, youknow, this crazydiet.
That's not fixing things forpeople.
Imean, the more that wehave, I think the sick are peopleare.
So what we really need is we need people tounderstand.
How this stuffworks.Yeah.
For the person who'slistening, who is in the twothirds, who are experiencing a gutissue, they love somebody whois.
What is available tothem?
If they truly take to hurt everything that you are about to sharetoday,Dr.
Robin. Not only is it possible for you to feel better in yourgut, because your gut is yourengine, it's possible for you to feel better in your whole body for you to have a clear mind and less brain fog for you to feel less fatigued for your immune system to work better so that you're not overreacting to things with food allergies or you're not underreacting to things where you can't clearinfection.
So the gut is a thing that unites all these differentorgans.
And that's the thing that makes me so optimistic because unlike when you think about geneticdiseases, youknow, you sort of get what youget, you don't getupset, you're dealt a bad genetichand.
But our gut is changing all thetime.
When we think about our gutmicrobiome, which I know we're going to talk a lotabout, we know from a study that was published in the journal Nature in2014, they put people on a sort of heavy high animal protein high fat adkins typediet.
And then they rested them for a week and they put them on a diet that was more plantfocused.
And they found that within 30 hours of the food hitting thegut, things changeddramatically.
The bacterial compositionchanged, the genetic composition changed in terms of the genes that were turned on andoff.
And the great thing here is you don't have to be avegan.
You don't even have to be avegetarian.
You just have to eat moreplants.
You have to do somebasics.
And infact, the American Gut Project study from 2019 that asked thequestion, what do you have to do to have a super healthymicrobiome?
They found that the label was completely unimportantcarnivore,omnivore,vegan,pescatarian,lacto-verte.
It was simply the number of different plantfoods, people ate with 30 or more different plant foods a week being the magicnumber.
So you can have your poor house or whatever it is that you're going tohave.
Imean, all my vegan friends will be veryupset.
But from a health point ofyou, there are reasons to consider eating less animal protein in terms of the ethics and climatechange,etc.
But from a health point ofview, you can definitely tolerate a little animal protein on theplate.
You can tolerate a lot of things on the plate if you are crowding it out with enough of the healthy stuff with some plants and some water and some movement and some of these basicthings.
You just said 30plants.
So are you saying 30 different types of plants or are there 30 like ones that are better thanothers?
Like as the gutdoctor, what should wedo?
Different plants perweek.
And when I sayplants, you get credit forfruits,vegetables,nuts,seeds,herbs,spices,beans, wholegrains, all ofthem.
Oh,well, if we include spices and nuts and grains likethat,absolutely, you could get 30 different things because I would imagine thevariety, what like is the variety alsoimportant?
The variety is important because they all contain differentthings.
When we think of thesephytochemicals, so you think eating the rainbow is always a good way to doit.
So you get different things from the oranges and you get the lycopene from the reds and you get something else from thegreen.
And so eating avariety, eating seasonally is another great way to do that because you're not in the same sort ofpeas,carrots,broccoli, heavyrotation.
Yep.For, youknow, 365days.
And it doesn't have to be a loteither.
Imean, you're getting enoughfrom, youknow, a little handful of berries isplenty.
You don't have to eat a whole quart ofstuff.
So as the gutexpert,Dr.
Robin, what do you eat in aday?
You walk us through like breakfast lunch anddinner?
Absolutely. I like to start off with a green smoothie in themorning.
Collards,kale,spinach,celery,parsley,mint, a little bit offruit, usually greenapple, lots oflemon.
I like to use ensuite and coconut water for thebase.
So when I drinkthat, it's like a liquid salad in themorning.
Imean, I feel so good when I havethat.
So I usually have that in themorning.
If I'm stillhungry, I'll usually have something high-ishprotein, maybe a little bit of smokesalmon, someeggs, or maybe a sweet potato and kalehash.
I love thattoo. And then what do you do forlunch?
Lunch is usuallysoup.Soup, soupperson.
Yeah.Okay. And there are a bunch that Imake.
My husband makes really good souptoo.
So it's usually split peas orlentils.
Sometimes it's just abroth.
I do a really basic soup that leaks onion garlic and scallionsauteed.
And then I just blended up with some brothdelicious.
Sometimes a little currypowder, depending on how I'mfeeling.
But that's all the goodstringy, high inulinfiber.
That's really good for your gutmicrobes.
So some kind ofsoup. Sometimes it's a heartiersoup.
And then dinner is usually proteinstarch, veg plussalad.
My husband's mostlyvegan, not all thetime, specialoccasions.
He might eat somemeat. So he's usually not doing theanimal.
He's almost never doing the animalprotein.
He's usually doinglentils, brownrice, sauteedcollards, andsalad.
And I'll have all ofthat, but I may have a little piece of fish or some broil shrimp orsomething.
But it's lots oflegumes.
It's lots of beans andgreens,basically.
And then some wholegrains, love brownrice, eat it probably mostdays, lovesquash, sweet potatoyams,yucca, all of thatstuff.
When you'reglowing, you'relike, this sounds actuallyamazing.
So do you need to take aprobiotic?
You need to eat an apple overtaking aprobiotic.
Yeah. Thisidea, and I willsay, I will say for therecord, there is dark chocolate happening every day forme.
Oh, thankGod. Tons of fruit and lots of darkchocolate.
Okay. And I have been known to eat a bag of Doritos on a roadtrip.
It hashappened.Okay.Well, I knew I likedyou.
But let's talk probiotics because they'reeverywhere.
Everybody seems to be onone.
And as the gutdoctor, what's your opinion aboutit?
My opinion on probiotics is likemultivitamins.
Do we have clarin compelling evidence that a multivitamin does anything for the averageperson?
Wedon't. What we know from some studies is that people who take vitamins also have healthyhabits.
So vitamin takers tend to be exercises and cleaneaters, it's andmeditators, etcetera.
But we don't have evidence outside of that that the vitamin itself in a healthyperson.
So it may help it can'thurt.
Even something like aprobiotic, if you're taking multiple differentspecies, those bacteria assuming that there are actually live bacteria in the probiotic because there's very little regulation a lot of times the bacteriadead.
But let's say thereare, let's say the product does contain what it says it contains these livebacteria.
They're potentially competing for resources with other bacterialspecies, even the native ones in your gut that are actually working and trying to do theirthing.
And now they'relike, ohwait, there's not enoughof, youknow, whatever resources we need toeat.
And so you can be altering your microbial composition for the worse by taking aprobiotic.
Oh,good.Now,well, I feel like I'm in the camp of everything you justsaid, it can'thurt.
And so I'll just keep like taking all these things and my body will just pee out whatever I don'tneed.
So that's one mistake I'm clearlymaking.
Second mistake that I'm making is I'm taking theprobiotic.
And then I'm taking a differentprobiotic.
And then I'm also eating the yogurt and thekimchi.
And I'm just making this gigantic sort of bacteriasalad.
But eat the kimchi forsure.
Imean, we have great data on fermentedfoods.
And a lot of this is from the son of Bern lab inStanford.
So kimchi and sauerkraut are this powerhouse combination of pre pro andpostbiotics.
And there's really compelling data that eating even a tablespoon of sauerkraut a day can provide multiple different species in portraitmetabolites.
So this is ultimately sort of medicinalfood.
Wow. Things like the sauerkraut andkimchi.
So by all means keep doingthat.
Dr.Robin, what's the difference between a prebiotic and aprobiotic?
A prebiotic is food for thebacteria.
So that's typicallyhealthy, fibrousfoods.
Probiotics refer to the actual bacteriathemselves.
Not just the one you're taking as asupplement, but the ones in yourgut.
So probiotics are bacteria and prebiotics are the food that bacteriaeat.
Gotit. And I want to try to bring in avisual.
So if you've ever made bread and you have that sort of you're starting it and you've got the yeast and the and you then feed the yeast with the flour and it starts tobubble.
The prebiotic thing is sort of like feeding theyeast.
And it'slike,oh, it's so I'm reallyhungry.
And I'm gettinggoing.Okay, gotit.
Theprobiotics, the actual other forms of bacteria that yougot.
Correct. Gotit. So what are the foods that you need to eat to like have both the prebiotic piece and the probioticpiece?
Forprebiotic, which are the foods to feed thebacteria, think high fiber and think stringy fiber like asparagus and celery and also things likeoats, dandeliongreens.
These are all greatfoods, fibrous foods to feed yourbacteria.
For probioticfoods, think aboutfermented.
They also contain prebiotic with thefiber, but think about fermented foods because those are producing bacteria during the fermentationprocess.
And I do want to say it's not that a probiotic is a total waste oftime.
In mypractice, where I treat really sick patients with Crohn's and UlsteadColitis, there are probiotics on the market that have the FDA label as a medicinalfood.
This is a medical food for the treatment of inflammatory boweldisease, etcetera.
There are products that have over a hundred different scientific studies behind them showing that they work for these particularconditions.
But that'sdifferent,right?
That's like the B12 for the Crohn'spatient.
That's not the averageperson.
The data that the average person gets a lot of health benefit or really any health benefit from taking a probiotic is a littlemurkyer.
And my concern is always that people are going tosay,oh, I don't need to change my diet or really pay attention to that because I'm taking theprobiotic.
Imean, you're actually eating the kimchi and doing all the otherstuff, which isfantastic.
And I'm popping theprobiotic.
And I think you're probablyokay, but you don't needit.
But I do want to cautionpeople.
If you're taking these high doseprobiotics, are you potentially using up resources that your native bacteria that need theseresources?
And how would youknow, like would you be bloated even though you're taking aprobiotic?
Like how would you know that it'sbackfire?
You reallydon't. You reallydon't.
There's not a test we can do forthat.
But what I want people to remember is that when you take a probioticproduct, those bacteria may be living half anhour, Imean, typically under anhour, in order to get meaningful colonization and repopulation of thegut, you have to feedthem.
And so the food is ultimately more important because the truth is it's not that you don't have any healthy bacteria in yourgut.
The population islow. How do youget,well, population may below, say you've taken a lot of antibiotics or you've had a crummydiet.
How do you manipulate the microbiome and get those healthy species to grow by feedingthem?
Not by bringing in more species that are basically going to like hang around 20 minutes and then you're going to poop themout.
So it's really this whole idea of repopulation andrecolonization.
And we do that by feeding what's alreadythere.
And that has beenshown.
And that's the American Gut Project study with a 30 differentplants.
When they asked thequestion, what is the most effectiveway, what is the most important thing to do to have a healthymicrobiome?
And this is a study done in over 10,000people, 40 differentcountries.
So really meaningfuldata.
And the most effective thing was to get 30 different sources of plant-based foods in your diet once aweek.
Yes, throughout theweek.
Wow. So it's still reallydiet.
Imean, if you look at an apple that's grown organically and even betterbiodynamically,biodynamically.
Biodynamically. When you have the animals fertilizing thesoil.
Oh, so you have them from a localfarm.
Exactly. Localfarm. I loveit.
That's what thatis.Exactly.
Local. Because it's going to be more nutrient andmicro-bredch, because it's not travel 3000 miles on aplane.
And it's barely alive and it gets you in order to keep thethings.
So an apple andapple, you can get millions of microbes from eating an apple grownlocally.
SoDr.Robin, I'm just imagining that the person listening is sitting here next tome.
And we have come to you because we feel bloated or we're struggling with IBS or constipation orwhatever.
And so it is just kind of a classic gutissue.
What are the three small habits that you would like us to start implementing into our day-to-day life that are the best things that we could do that will build ahealthy, beautiful kind of gut microbiome and get our gut system workingcorrectly.
There are tons of things todo.
But if I had to distill it down tothree, I would say it'shydration, it's movement and it'sfiber.
And the movement that's smoothmuscle, it's not skeletalmuscle.
So it's not on the voluntarycontrol.
But we know that movement creates nitricoxide.
And nitric oxide is part of what keeps the heart healthy and keeps the guthealthy.
And so the movement stimulatesparasitosis.
If you don't have things moving through in a timelyfashion, not only do you have symptoms like bloating andconstipation, but you also have stasis of those intestinal contents and you have bacterial overgrowth because things aren't movingthrough.
So the movement is reallyimportant.
And I found that since pandemic somuch, so many of us are sosedentary.
I know that I'm not at the hospital a few days a week anymore back and forth where I'm probably walking four or five miles everyday.
I'm sitting a lotmore. And I think we've seen a huge effect of that of the youknow, effect of being sedentary on thegut.
So we need to stimulate gutparasitosis.
The people we see with the worst GI problems are people in nursinghomes.
And it's not because they'reelderly.
It's because they're notmoving.
So movement is reallykey.
Hydration, I can't say it enough timesplumbing.
We've got to unclog thosepipes.
And then the fiber because the fiber feeds are gutmicrobes.
So they can ferment thatfiber, create all the healthymetabolites.
And it doesn't have to be like some enormous kalesalad.
It can literally be grab a carrot as you're walking out the door and chomp onit.
Throw an apple in yourcar.
Eat somenuts. Somethingbasic, ideally something onprocess,right?
I love how accessible this is because based on everything that you are teachingus, your body is naturally designed to work in the correctway.
It isplumbing. It's trying itsbest.
And so if you get all different kinds ofplant-based, fiber-ist foodsin, the research says try 30 different types of spices and foods inthat.
And if you simply walkmore, you're saying that that's three things that we can do that will help over time create a healthygut.
Tremendousbenefits.Tremendous.
Youknow, the water thing is like a drug when you really startto, and I was one of those people who for years walked around sort ofdehydrated.
Imean, I drink a lot if I was at heated vignasse flow yoga orrunning.
But other thanthat, I waslike, I can't be gettingup.
I'm seeingpatients. I don't want to get up every five minutes and have topee.
And then I started measuring and drinking a hundred ounces ofwater.
I noticed a tremendousdifference.
Imean, I already have pretty goodpoos.
I have tosay. I'll show you some pictureslater,Mal.
Butthese, Imean, just dramaticimprovement.
And they perk up like how briskly they come out because things arelubricated.
Youknow, I never thought I would say to a GIdoc, I could listen to you allday, but Icould.
And there are so many people in mylife,Dr.
Robin that need thisinformation.
And so I want to take a quick pause so we can hear a word from oursponsors.
They bringyou,Dr. Robin at zerocosts.
So let's give him a littlelove.
But you know who else I want you to give a little love to the people in your life that need this life changinginformation?
Those friends that are complaining about theirstomach, the people that have all kinds ofissues, send them thisepisode.
It could really change their health and change yourlife.
Allrighty. Don't goanywhere.
We will be waiting for you after a short break with more fromDr.
Robin. Welcomeback. It's your friend Mal and you and I are here with the incredibleDr.
RobinChutkin. And we're learning all about guthealth.
I really do want to dig into you having you help us understand specific gut issues like bloating and IBS and some of the things that people really strugglewith.
But before we gothere, I would love for you to explain to us why should we care about a healthygut?
And what I'm trying to ask is what is it impacting when your gut is healthy and when it'snot?
You said earlier that there's a big connection between your immune system and your guthealth, which I didn'tknow.
And so if you could just elevate this issue for us at the highestlevel, like why beyond our plumbingworking, does your gut health mean totalhealth?
The gut immune connection is probably the most important connection for the gut and otherorgans.
You have the gut lining and on one side you have the trillions of microbes in yourgut, yourmicrobiome.
And on the otherside, you have the immunecells.
And that gut lining is only one cellthick.
It's a razor blade separating your gut microbiome from the immuneprocesses.
And it's a hand and gloverelationship.
They're workingtogether.
Literally the microbes are like the lookouts and they'relike,oh, something problematic comingalong.
They trigger the immunesystem.
In somecases, they actually kick on the lining of thegut.
They push on it to trigger the immuneprocesses.
It's a physical interactionsometimes.
But they signal the immune cells on the other side tosay,oh,whoa, somethingbig.
Here comes Ebola orSARS-CoV-2.
You guys need to getready.
Mountain immuneresponse.
Start makingantibodies.
T cellsmobilize. Let me just make sure I'm understanding why this matters because based on what you're consuming through your mouth that gets processed through this 30-foottube, your gut is extracting intelligence that mobilizes other parts of your body to help you outside of thistube.
Absolutely. Your gut microbiome directs your immunesystem.
It literally trainsit.
And this is why we see there's a fascinating theory called the hygienehypothesis.
It was developed by DavidStraun.
He was a epidemiologist in Britain in the1950s.
He did a study of over 17,000 children from birth toadulthood.
So a long period of time to figure out why they were seeing these high rates of autoimmune diseases in England and post-industrialLondon.
He found that kids who were exposed to moregerms, who were living in largehouseholds, were cousins and siblings were always sneezing and coughing onthem.
They were immunized because their immune system had been trained at an earlyage.
How to differentiate between friend andfoe?
And whether to mount an immune response ornot, how high an immuneresponse?
Kids who are superclean, who are neversick, they had higher rates of autoimmune disease lateron.
AndMel, if we look at a map of the worldtoday, we still see the effects of the hygienehypothesis.
We still see high rates of autoimmune disease in countries where there are higher levels ofsanitation.
There's morewashing, there's morechlorination, there are morechemicals, there are fewer microbes compared to less developed countries where people have close contact withanimals, they have close contact to thesoil, they're growing their ownfood.
So the immune system needs exposure to microbes early on in order to trainit.
So it can set it at just the rightlevel.
What we're seeing now in more developed countries like the United States is we're seeing an overactive immunesystem, which is manifest as autoimmunedisease, one in fourAmericans, many people have multiple orallergies, foodallergies, everybody's got anallergy.
Why? Why do we have a foodallergy?
Because of an over reactive immunesystem.
And why do we have an over reactive immune system because of what's going on in ourgut?
There is a very directcorrelation.
CanI, let me see if I can explain this tomyself.
So you're basically saying that when your gut is out of whack and it's getting all kinds of mixed signals because if your microbiomes and the gut health isn'tintact, it's actually not able to either break things down or read what's coming incorrectly.
And then that means it is not able to signal in an efficient and effective way to your immune system that either we got to go into battle or everything isokay.
And so because our guts are out ofwhack, we're not gettinghydration, we're notmoving, we're not taking care of ourselves and eating the virusfoods, this is causing our immune systems to gohaywire.
And this is sofascinating.
And Iactually, I actually readsomewhere, I don't know if this istrue, that80% of people that at least in the United States that have an autoimmune disorder orwomen.
Yes. Why does thishappen?
I have a very highrange.
And Gabo Mati talks about this and otherfolks.
We think it may have something to do with the effect of the femalehormones,estrogen,progesterone, etcetera, and the interaction with thegut.
And also because some of these genetic predisposers for autoimmune disease are sex linked to their tide to the Xchromosome.
So a couple of differentreasons.
I also worry about the personal careproducts, thecosmetics, other things that women tend to use more of that are getting absorbed into the body and how those might be affecting women because youknow, you think aboutit.
You put makeup on at 10 o'clock in the morning at 10 o'clock atnight.
It'slike, where's themakeup?
It's allgone. Where's itgone?
It's got absorbed into ourbody.
Andagain, I'm not saying that makeup causes autoimmunedisease.
Let's beclear. But we put a lot of things on our skin and after our GItract, our skin is our next biggest digestiveorgan.
Our skin literally digests the things we're putting onit.
And so we have to alsothink, youknow, what are we putting on our hair orskin, etcetera, that could be getting absorbed into our body that could potentially be triggering an immuneresponse.
So that's just one of severaltheories.
And like mostdiseases, likecancer, likedementia, it's not onecause.
Right. It's multiple differentfactors.
But is there research or do you see in your clinical practice if you are doing these interventions that anybody cando?
Drink morewater, move yourbody, eat more like fibrous foods in yourdiet.
When you can start to get your microbiome and your gut health and your plumbing working as itshould, do you see an impact on an autoimmunedisorder?
Most of what I do in my practice now is helping people with complex autoimmune disorders like Crohn's and ElisativeCalitis.
Get off immune suppressingdrugs.
And do you know how we doit,Mel?
No, we do it with diet andlifestyle.
And if you had told me 27 years ago when I finished my GI fellowship that I would be treating complex autoimmune diseases withfood, I would have laughed atyou.
And I would havesaid, haha, that'shocus, pocuscraziness.
But now when I think aboutit, I think about my colleagues saying tome, does that stuff reallywork?
And I'mlike, are you asking me as a fellowgastroenterologist, if what you put into your gut affects what's going on in your gut and you're askingme, is that howit, Imean, ofcourse, that's how itworks.
What we put into our gut profoundly impacts what's going on in our gut and what's going on in our gut profoundly impacts what's going on in the rest of thebody.
So Imean,it's, it is very contrary to the prevailing wisdom of all the biologics and the immunosuppressants you see advertised on television and that's a gazillion dollarindustry.
But I will tellyou,Mel, we have published data on this and we have a success rate of about79% getting patients off of these biologictreatments.
Now, I will tell you it doesn't work ineveryone.
And it's a cherry pick population because people are coming to see me fancy GI docwho, youknow, they've got to travel out whatever come and see and they'remotivated.
Butthe, but the intervention is what anybody coulddo.
The intervention is whatanybody, the intervention is notany, youknow, specialdiet, you have to go and buy ourproducts.
Itis, Imean, we sometimes do use this very high potencyprobiotic.
The one I mentioned that has the indication as a medical food for IBD will often use that inconjunction.
But it's always a dietary change and I'll tell you the diet that I put patientsout.
It's similar to what Ieat.
It's a green smoothie in the morning and I tell them if you do nothingelse, do this greensmoothie, get in your three leafygreens, a littlecelery, the parsley and mint are forme, just forflavor,fruit,ice, little lemon fortaste, get that in in themorning.
And I usually start people on about 12 ounces and then I work them up to 40 ounces of this greensmoothie.
Okay. And it's all just stuff you buy at thesupermarket.
And I always felt like I was sort of alone out there in the wildernesssaying, youknow, eatfood, realfood, it will make adifference.
It's a green smoothie in themorning.
And I tellpeople,look, if you're stillhungry, have someeggs, make anomelet, definitely have something else forsure.
And then forlunch, it's usually something based aroundplants.
So I'll encourage mypatients, I'll say get a salad that's usually easy for people toget.
And if you want some animalprotein, go forit.
But make sure it's a big salad and ideally put some chickpeas in there or some hummus on thesides, a lots ofplants.
Okay. And then fordinner, if you are an animal proteineater, yourprotein, yourstarch, your two veg plussalad.
And that'sit. There's a form of sensibleeating.
And it's also getting people to cut down or ideally eliminate the ultra processfoods, the package foods with all theemulsifiers.
In my neck of thewoods, for autoimmune diseases in the GItract, we see that theemulsifiers, the soylessifin,carodine, and those things are particularly bad for thegut.
And we think it's not so muchmicrobiome, but it's a gut lining that they compromise a gut lining in someway.
What are some other parts of your overall health that are driven by gut health that might surprise someone toknow?
Your estrogenlevels. I did not learn this in medicalschool.
When I found this out a decade or soago, I was mesmerized by something called theestrabalom.
And the estrabalom refers to a collection of bacteria in your gut that metabolizeestrogen.
So when the estrogen is made primarily in the ovaries and a little bit in the adrenalglands, and it travels through the bloodstream to all the different parts of the body that have estrogenreceptors.
And that's not just theuterus.
That's also hearttissue, different parts of ourbrain, etcetera, that have estrogenreceptors.
And then the estrogen that's not used getstransported, it gets into thebile, and it gets excreted into thegut.
And it gets recycled through thegut.
So there's certain bacteria in the gut that help to recyclethat.
Some of it gets excretedout, and some of it gets reabsorbed back through the lining into thebloodstream.
If the estrabalom isdisrupted, you get higher levels of reabsorption than youshould.
And you end up with a situation called estrogendominance, where you have too much estrogen onboard.
And that is associated with a lot of conditions withfibroids, withendometriosis, with a lot of the menopausal symptoms we thinkof.
Andagain, this isn't the only reason forsure,right?
But thisis, most people don't realize that the gut plays a huge role in estrogenmetabolism.
So if you've been taking antibiotics nonstopfor, youknow, whatever they may have been prescribed fordecades,exactly.
Not, youknow, I had a strepthroat, I tookantibiotics, but somebody put you on antibiotics for yourskin, told you have a chronic inflammatorycondition, maybeRizesha, take theseantibiotics, or because you're getting frequent urinary tractinfections, take the antibiotics every time you havesex.
And, youknow, that could add up depending on who youare.
So so many of the patients I see and so many women in particular are put on these suppressiveantibiotics, not to treat an actualinfection, but to treat inflammation or to prevent aninfection.
And that ends up being ruinous to your gutbacteria.
And that ends up affecting your estrogenmetabolism.
And throwing your estrogen levels offbalance.
So I really particularly for my menopausalwoman, and particularly because I'm a menopausalmyself, reallyfocus, really take a gut centric approach tothat, to really look at you've got to have a healthy gut if you want to go through menopausesuccessfully.
And there've been some really interestingarticles,Dr.
Neil Bernard at the Physicians Committee for ResponsibleMedicine.
And they're very much a plant-basedorganization.
They published a study that looked at a plant-based diet for visa motor symptoms in menopause for hotflashes, way more effective than hormonereplacement.
Wow. And the thing that I find in my patient population is it doesn't have to be a completely plant-baseddiet.
Now, Neil and his colleagues werewonderful.
People would tell you that it shouldbe, but youknow, we live in the real world and not everybody's going to become a vegan to control their hotflashes, but just eating more plants and eating a plant-baseddinner, having your last meal before you go tobed, be primarily plants can helpdramatically.
If I want to induce a hotflash, I don't have manymore, but if I want to induceone, I have a Porta House steak and some red wine atnight.
And I just want to say the samething.
Up allnight. I'm just going to say the samething.
Because digestion is such an active process and particularly digesting animal protein that's high infat, high in protein requires a lot of bloodflow, a lot of enzymatic activity that leads to a lot of dilation andflushing.
And ofcourse, the alcohol is going to visa dilate youtoo.
I think you just inspired me to make a majorchange, especially during the weeks that I have like a really big workload or I'm traveling forwork.
So I got to get up in the morning and give a big keynote in front of thousands ofpeople.
I alwaysthink,oh, I should have a steaktonight.
I should have a piece of fishtonight.
I should have a big protein thing to carry me through and what I'm gathering from you is I would be way better off if I heavy loaded on the leafy greens and the vegetables and a lot of water at night because it would allow my gut to just flushitself.
Rest in thelab.Yes.Yeah.
And thinkabout, Imean, the protein can be satin and it can carry youthrough, but think about having a high protein breakfast the daybefore.
Like, have an omelet the day before or have more protein atlunch, but then fordinner, really lighten it up early andlight, supersolid.
Perfect. Youknow, I love this because so many of the experts that have comeon, because you've been talking to a lot of people about hormones and men of cause and for women inparticular, how you age well so that you have energy and you're strong and you're able to be like vibrant and as you age and so much of the message is about resistance training and just lots and lots and lots ofprotein,right?
And so I think really trying to get the big protein in the morning and at lunch is the way togo.
But I like so I'm learning somuch.
Can you explain the connection between the gut and the brain to the personlistening?
The gut brain connection is another fascinatingone.
I think gut immune and gut brain rightnow.
We have a whole separate nervous system in our gut called the enteric nervoussystem.
And it'smany, many millions of nervecells.
Infact, we have about seven times the number of nerve cells in our gut that we have in our spinalcord.
Not as much as we have in our central nervous systemclearly, but the gut is a very innovativeorgan.
A lot of nervecells.Okay, gotyou.
It also communicates directly with the brain via the vagusnerve, the 10th cranialnerve, messages going back andforth.
The gut also is where most of the neurotransmitters areproduced.
Serotonin, the feel good hormonedopamine, severalothers.
Most of them are produced in thegut.
They're co-manufactured bybacteria.
I think that is a surprise to most people because you hear the word serotonin and you thinkbrain.
But you're here to tell usDr.
Robin,no,no,no,no, your gut health is critical because the serotonin that youneed, most of it is manufactured in ahealthy, healthygut.
So what we see is that with a disruptedgut, we see abnormalities inmood, incognition, inmemory.
Andconversely, because it'sbi-directional, it's gut affecting brain and brain affectinggut.
We see the brain influence on gutmotility, enzymesecretion, and absorption ofnutrients.
So you've got to have it inbalance.
And it's not eitheror. It's not either you take an SSRI or you eathealthily.
It'sboth. And particularly for youngpeople, the idea that you can take a young person who's struggling with mental healthissues, and they can be eating cheetos and cheeseburgers while you're meditating them and you're not paying attention to what they're eating is magicalthinking.
We have to pay attention to that for brain healthalso.
Is there a scientific link between depression and anxiety and guthealth?
Thereare. And like a lot of theseconditions, it'smultifactorial.
But I'll give you just a basicexample.
There's a bacteria called Campola BacterJijunai, which is a common cause of food borneillnesses.
And sometimes people will get it with a travels diarrhea when they're out of town orsomething.
Inmice, if you inject a large inoculum of Campola BacterJijunai, you induce anxiety inmice.
What's a human carlet forthat?
Post-infectious irritable bowelsyndrome, which is what we refer to when somebody has a change in bowel habits that's happening after aninfection.
Often after an infection like Campola BacterJijunai.
Post-infectious irritable bowel syndrome doesn't just affect your bowel habits where now the bowel habits areirregular, maybe they'relooser, they're morefrequent.
It also frequently involves changes inmood.
People will say they're moreanxious.
Youknow, I went to theCaribbean.
I got travelsdiarrhea.
I was inMexico. I got Montezuma's revenge and I came back and my bowel habits haven't been thesame.
But I also find I'm moreanxious.
My mood seems to havechanged.
And we think a lot of that is mediated through the change in themicrobiome.
Wow. Let's talk about IBS because I have a number of friends and family members that are struggling withit.
So what should somebody do if they think they haveIBS?
What would you say these are the steps I would take before you go running for some sort ofdrug?
Number one is you have to figure out what is causingit.
And I like to think in terms of generalcategory.
So is it somethingmechanical?
If you're awoman, when was your lastultrasound?
Do you have a bigfibroid?
Could there beendometriosis?
Do you have an antivirted uterus or a prolapse bladder or something that's pressing onit?
So what is an anatomical mechanical thing going on that could be causingsymptoms?
Okay. Medicine cabinet is a bigone.
And it's not just prescriptiondrugs, but it's also over the counter andsupplements.
So you need to look at the side effects and what am I lookingfor?
All ofthem. You're looking for things that have GI sideeffects,nausea,vomiting,diarrhea,constipation.
And then that everymedication.
It's alot, but I'll tell you when they list sideeffects, they list the most commonones.
First, it's like ingredients at a foodlabel,right?
So the most common ingredient is listed at thetop.
And bycommon, you mean this is the sideeffect, we see themost.
Exactly.Okay.Yes. So if you seenausea,vomiting, abdominalpain,constipation, diarrhea in the topfive, and you are having some of thosesymptoms, that's something that's worth checkingout.
Andagain, not advocating that you take a drug holiday on yourroad, but talk to theprescriber.
And here's thething. Your psychiatrist might be prescribing a drug for you foranxiety.
And the drug may be helping youranxiety, but it may be causing a whole different problem in the GItract.
I have to remind people that just because something is helpful doesn't mean it's a goodidea.
And I tell people all thetime, if you're tired and I gave you somecocaine, it would pep you rightup.
But does that mean cocaine is a good idea for treatingfatigue?
So in mypractice, I spend so much time trying to undo sort of medicalmisadventure.
I like to call it where a very well-meaning physician prescribed something for his or her neck of thewoods, a kidneyproblem, a psychiatricproblem, a lungproblem.
And it's going great for thatproblem.
But it's messing up my organnow.
So we're very siloed inmedicine.
Youknow, the nephrologist is the kidneys and the pulmonologist is alungs.
And everybody's just sort of focused on theirthing.
And because the medicine cabinet is such a problem in the GItract, and as yousaid,Mel, but youknow, don't all these drugs have GI sideeffects?
Many of them do because youknow, you ingestthem.
So they potentially affect the pH of thegut, they potentially affect the gutlining, and they potentially affect the gutmicrobiome.
And then those things affect the immunesystem, etcetera.
So it becomes a sort ofwhack-a-moe.
Like you whack one problemhere, your high bloodpressure, fantastic blood pressure iscontrolled.
Now we have a problem overhere.
So we whack that with anothermedicine.
And so it'spolypharmacy.
And when I seepeople, the first thing I want to figure outis, is this a side effect I'm treating because it oftenis.
Right. So is there constipation or they're bloating a side effect of a medication they'retaking?
And the sometimes challenging thing is people don't want to hearthat.
They want like the magicpotion, like give me the magic supplement probiotic that's going to make the cell goaway.
So I have people bring theirmedications, they're over thecounter, thesupplements,everything, and I lay them all out on thetable.
And the people in my office always laugh because I always have my rubbish bin right next door because they'relike,oh, this is going to fillup.
And I'mlike,okay, thisone, what's this onefor?
And to beclear, I would never tell somebody to stop a prescription medication that I didn'tprescribe.
I tell them thisone, you got to talk to your prescriberabout.
But I divide itup. And usually by the time I'mdone, it's a pretty small group that's what is kind of the first thing that you'relike,no,no,Advil, noaspirin, nothis, like the thing that you take all thetime, the non-steroidal anti-inflammatorydrugs.
What isthat?Advil,Aniston,Alive,ibuprofen.
So when we look at the emergency visits for gastrointestinalbleeding, number onecause.
Toomuch, too muchibuprofen.
Wow. People don't realize that over indexing on this stuff can cause fatal gastrointestinalbleeding.
There was not a weekend on call when we were not in the intensive care unit with our scopes trying to stopdramatic, youknow, near fatal gastrointestinalbleeding.
Wow. So these drugs can be potentially reallydangerous.
You have to be careful withthem.
And I'm assuming that if this is kind of the detective work you'redoing, that it's still the same three things that you would recommend in terms of movement and water and diet overcompensate.
But you got to you can't fill a bathtub with the stopperout,right?
So if you're trying to improve guthealth, fill thebathtub, you have to make sure that it's stoppedup, that you're not draining all the good stuff you're doingout.
I like this concept of personalizedmedicine, but personalizedmedicine, not in the sense oflike, youknow, all these wonky tests andsupplements, but personalized medicine in terms of sitting down and really figuring out what are the things that you're dealing with and what is a backgroundnoise?
What is a platform on which your symptoms or illnesslive?
Is that platform standard Americandiet, youknow, only eat abroccoli, abroccoli, floret once aweek, because you're onlyvegetable?
Is it massive amounts of antibiotics inchildhood?
As was a case with mydaughter?
Is it really sedentary and no timeoutside?
So you've got to look at thatplatform.
See what you can change and then start to addon,right?
Youknow, just start adding on all the medication withoutreally.
And even thinking about the othermedication, how are these four other medications you may be taking for high blood pressure or somethingelse?
How are they affecting theliver?
As I'm listening toyou, I'm not only thinking about myself and the personallistening, but I've got at least five people that I have to send this episode to like rightnow.
And so let's take a quick break so we can hear a word from oursponsors.
And while you're listening to thesponsors, share this episode with your friends and with yourfamily.
Anybody that's been complaining about stomach or gutissues, they needDr.
Robin in theirlife. So send them thisepisode.
And don't go anywhere because we'll be waiting for you after a shortbreak.
Stay withus. Welcomeback.
It's your friend Mel Robbins and you and I are here with the incredibleDr.
Robin Chutkin and you and I are learning absolutely everything related to gut health and moreimportantly, how to make itbetter.
SoDr.Robin, here's where I want to gonext.
One thing that I want to talk about with you today ispoop.
Like what should we be lookingfor?
What'shealthy? What'snot?
My favorite thing to talk about andMel, I am so curious about yourpoop.
If you are willing toshare, I know I'm not the only one who wants to know like what are Mel Robbins bowel habitslike?
I, youknow, I'm the kind of person you ask thequestion.
I'm going to tellyou. So I'm happy to talk about mypoop.
I have a feeling that you have wonderful poos because youjust, you have thisglow.
You seem reallyhealthy.
Okay. Do you really want toknow?
Yes. I don't want toknow.
So I am a once a dayperson.
Excellent. I typically go in the morning and I have one of those little stools that squatty potty that you that you put up and if I can't find a stool like if metalhotel, I pulled a little garbage can over on myfeet.
I have like avery, I think it'shealthy.
Imean, I don't even know what healthy poopis.
I just know that when it comes out kind of in oneshape,perfect, and it's somewhat soft and held together and there's not a lot of strange objects in it that that's probablyhealthy.
I don't like it like if I have a situation where I'm not doing well and I'm superstressed, I might go a day withoutpooping, but typically never more than a day ortwo, and then when thathappens, it looks like milk duds and I know I'm in trouble and I'm nothealthy.
How am I doingdoc? Stoolnirvana,baby.
Is that what you gotit? Stoolnirvana.
You hit all the so daily good color formed and it also sounds like you feel good when it comesout,right?
There's that feeling oflike,yeah, I amT.
Idetoxed. I'm good togo.
I'm prettyefficient. I don't spend a lot of time inthere.
I can getin. I can getout.
But that does beg thequestion.
How often should you begoing?
How often do youeat? Do you eat everyday?
Ofcourse. At least once aday.
Yes. You should be eliminating once aday.
So thisidea, we have this textbook definition that it's three or more bowel movements a week isnormal, but if you're going underthree, you'reconstipated.
It's a very arbitrarynumber.
And when we think aboutconstipation, we're usually thinking about things likeconsistency.
Youknow, is it stool hard or is itsoft?
How much is comingout? But it should absolutely be a daily thing because that's what itis.
It'selimination. It's eliminating dead bloodcells.
It's eliminatingbacteria,toxins,etc.
Undigested foodparticles.
That stuff is not supposed to be gumming up your cola and just sittingthere,right?
Everybody that does not go number two once aday, just lean in andthought, ohgosh, what do Ido?
So if you're somebody that is not going once a day that doesn't have kind of a satisfying experience with this or kind ofreliable, what are the first couple steps that you want somebody todo?
I think the first thing again is recognizing that this should bedaily.
Now that beingsaid, if you skip a day here andthere, you're traveling schedules a little bitdifferent, that's nothing to worryabout.
But how can we help people go everyday?
So I want people to consider a couplethings.
What they're puttingin, how they're stimulating thegut, and that's primarily withmovement, and what they might bedoing, that's slowing thingsdown, the gutmotility.
So what you're puttingin, you want to make sure you're putting in afiber, you want to make sure you're putting enough waterliquid.
It'splumbing. The GI tract ispipes.
Infact, a plumber was at my house on day fixing something and I was standing over him and he kept looking at me and he waslike, are you checking what I'mdoing?
I'mlike,no,no,no, we're just in the samebusiness.
You just make a lot more money than Ido.
So I'm just looking at what you're doinghere.
But it'splumbing. It's one long pipe from north tosouth, about 30 feetlong, and things get clogged along theway.
And what do you do when your pipe isclogged?
Thinliquids, lots ofwater.
So I tell people my rule of thumb half your body weight in ounces of water as aminimal.
And that's just plainwater.
We don't need electrolytes init.
We don't needflavoring.
Those things often are irritating to thegut.
So just plainwater, half your body weight in ounces of water as aminimum.
And that makes a tremendousdifference.
I can probably solve50% of the constipation I've seen my office just by getting people tohydrate.
Wow. And by theway, as youknow, great for your skin and everythingelse,right?
So so many of us are walking arounddehydrated.
So takeaway number one is thinking about your gut system as a 30 foot long plumbingsystem.
It starts with yourthroat, moves all through your body and right out the shoot atthe, youknow, at thebottom.
Absolutely. And that half of your body weight is what you should be hydrating with just plain water everyday.
And as a medical doctor specializing inthis,50% of constipation issues can be solved by simply hydratingcorrectly.
Imean, it's ageneralization, but50% of the people I see in my office who are bloated and constipated and youknow, things are sluggish when I get them to really start hydrating things perc rightup.
I also want to point out that the female plumbing system is very different from the male plumbingsystem.
Oh,how? And that's because of three mainreasons.
So if you have had acolonoscopy, if you're 45 orover, you should have had acolonoscopy.
And you may have beentold, particularly if you're a woman that you have either a redundant colon or a torturous colon or a twistedcolon.
And the reason that's more common in women is because of anatomicaldifferences.
So numberone, we have a longer digestivetract.
Are colons on average are about three to five incheslonger?
Why?Well, that first ofall, it may not seem like alot.
It seems like three to fiveinches.
Three to fiveinches. If you think fiveinches, that's like from your rear end of your bellybutton.
Exactly. It is alot. And that extra length creates more looping andtwisting.
And so things are more likely to getstuck.
And that's one of the main reasons women tend to be so much more bloated andconstipated.
The reason why is to allow for more fluid absorption duringpregnancy.
Sofluid, the colon does twothings.
It gets a product of digestion from north tosouth, but does more than twothings, but two bigthings.
And then it also reabsorbs water from theinside, from the stool through the lining of the colon into thebloodstream.
So the reason that women have a slightly longer colon is so that when we arepregnant, we can reabsorbe more water through the colon to maintain the amnioticfluid.
Let me just see if I can extract that so that those of us without your amazing medical knowledge and degrees understandthis.
Because I think that'sfascinating.
See, did you just say that one of the things that your colon is doing is when the waste is moving through yourcolon?
The colon is actually removingwater,yes, and moisture from the waste matter and recycling that water through your body so that as awoman, you can make the amnioticfluid, you can do other things that are part of the reproductivecycle.
100%. And so when if you were to go up into a colonoscopy as somebody is having a bomber'smet, which I don'trecommend, we'd like to have the colon cleaned out when we're doingthat.
What you would see is that when the stool hits the top of thecolon, it'sliquid.
What? It's liquid and it'sgreen.
It's billiastfluid. And as it moves through the five to seven feet of colon at theend, the fluid gets reabsorbed so that what comes out at the end is a beautiful melrabon stoolnirvana, chocolateybrown,gorgeous.
We need to make us some t-shirts for you thatsay, I have greatpoops.
Oh mygod. I don't want people looking in the toilet andgoing, that looks likemelrabon, rightthere.
It's smiling right back atyou.
So at theend, you get this chocolatey brownthing.
So how do you turn liquid green at the top of the colon to solid brown at thebottom?
The colon reabsorbs the fluid and all the bacteria that are primarily in thecolon, your bacteria throughout your whole GItract, but they're concentrated at thebottom.
The bacteria get dumpedin, the dead bacteria and the dead red bloodcells.
And that turns itbrown.
And so that process happens in thecolon.
The absorption ofnutrients, the vitaminA,D,E, andK, theiron, all that stuff gets absorbed upstream in your smallintestine.
So the function of the colon transport theproducts, reabsorbwater, ferment the products of digestion with all the gut bacteria so that you end up with a chocolatey brownstool.
This isfascinating. Isn'tit?
Imean, it is sofascinating.
Who is sofascinating? So the longer colon is just reason numberone.
Reason numbertwo, why we're more bloated andconstipated, is that we have a deeper widerpelvis.
The female pelvis is called a gynecoidpelvis.
And the male pelvis is an Androidpelvis.
What that means is that our colon falls deeper down into the pelvis where it has to compete forspace.
What else is in thepelvis?
Youruterus, your fallopiantubes, yourovaries, yourbladder.
That's a lot ofhardware.
Inmen, they just have a prostate gland that's about the size of awalnut.
So there's much moreroom.
If you look at two skeletons side byside, male andfemale, you can tell thefemale.
The pelvis is likewings.
And the male isstraight.
Andagain, what's thereason?
Childbearing. So that we can accommodate a whole human being downthere.
So that's reason numbertwo.
So these are both sort of anatomicalreasons,right?
Longercolon, deeper widerpelvis.
Reason numberthree, we have lower testosteronelevels.
Okay.Well, what does thatmean?
Testosterone does a lot ofthings.
Andagain, youknow, it's not that we don't haveany, but we haveless.
And one of the things testosterone does is it makes the muscles in the body kind of stronger or morerigid.
So men have a tighter abdominal wall because they have moretestosterone.
So even a man with a big bearbelly, he'll complain about having a bearbelly, but he won't complain about being bloated because underneath his bear belly is a nice tightspanks.
And we've got a stretched out spanks because of the lower testosteronelevels.
So these three things really conspire to blow and constipateus.
And if you look at the medicalliterature, you'll see all these articles about why colonoscopy is harder inwomen.
It takeslonger. We require moresedation.
And that'strue. But it's not because we have a lower painthreshold.
It's because we have all these anatomical thingsthat, youknow, are there forreason.
They're not a designflaw, but they also conspire to make us more backedup.
Can we talk a little bit aboutconstipation?
Love talking aboutconstipation.
Why you love talking aboutconstipation?
Constipation is so satisfying because there's so many different things that causeit.
And often people are dealing with two or threethings.
And when people feelbetter, it'slike, youknow, they're sohappy.
And the other reason I love treatingconstipation, sorry tointerrupt, is because bloating is constipation's fellowtraveler.
And so when people areconstipated, they're almost always bloated because they're justplugged.
And so when you relieve theconstipation, you deblowthem.
And they'rethrilled. And the other thing is a lot of people who are bloated don't even realize they'reconstipated.
You can have a bowel movement every single day and still beconstipated.
You can have two bowel movements a day and beconstipated.
If you are having something called incompleteevacuation,Tinesmus.
And Tinesmus is like the newinsomnia.
So think aboutit. When we think aboutinsomnia, wethink,okay, I've trouble fallingasleep.
But most people haveinsomnia.
Don't have trouble fallingasleep.
They go to sleepfine, but they wake up and they can't go back tosleep.
Imean, I know that's myissue.
I go right to sleep and I popaway.
Can I start ruminating and I can't go back tosleep.
Well,constipation, Tinesmus is kind of likethat.
It's not that you're notgoing.
You're having a bowelmovement, but it'sincomplete.
And you can tell that your colon isempty.
Youknow, you've got that like feeling like I still got something on the launchpad.
Yeah. And often it's a schmary wipe because when you wipe and there's still a lot of stool onit, that's because there's stool still in the rectum that hasn't comeout.
So you don't have that good clean wipe where it'slike,ah,look, nothing on the toiletpaper.
That's that's part of stool nirvana is a cleanwipe.
So what so you said that there were lots of different causes and lots of different things you cando.
So can you walk us through the things that cause constipation that might surprisepeople?
It's very similar to the irritable bowel syndrome to the IBSclassifications.
Somechanical, do you have a voluptuous venouscolon?
Do you havefibroids? Have you had surgery and you have scartissue?
Do you have a prolapsed bladder orrectum?
So what's going onmechanically?
Medicinecabinet, I think I beat that horse todeath.
And thenhormones, do you have potentially undiagnosedhypothyroidism?
Do youhave,ah, are you earlymenopause?
And now you're more constipated because ofthat.
Andremember, perimenopause starts like 10 years before you stop having yourperiod.
So could it be a hormonalproblem?
Could it be a physiological motilityproblem?
And the motility is very tied to the composition of the gutbacteria.
So believe it ornot, antibiotics that you took 10 years ago and affected your microbiome can now be causing your gut to slow down or go too fast and not functionproperly.
I have somebody that I love that is chronicallyconstipated.
Andlike, we'll go four or five days and that is consistently what their experienceis.
And what do you think the reasonsare?
Have you had to have you done any slewthing?
Ihave. And it's a very healthy person exercises all thetime.
It has a very cleandiet.
Does not take any like not a lot ofmedication.
Young. And I personally think it is an issue with the muscles and not like somehow training yourself to clench when you should bereleasing.
It's a hugecategory. And I'm so glad you brought it up because I had overlooked that when we were talking aboutit.
So can you describe what thismeans?
Because I think for people that also have ashot, they're your shy aboutpooping.
It's aroundpeople. They're the medical terms are things likeenismus.
And some of these are pelvic floorissues.
And I know you've had pelvic floor peopleon, but it is tightening when you should bereleasing.
And what we're talking about here now isn't really a pelvic floorissue.
It is a muscularissue. And it's exactly what you said shybowel.
The technical term isparcoprisis.
It's also called psychogenic fecalretention.
And it's classified as a psychiatricproblem.
But there are some really important physiological things that make me think it's misclassified as a psychiatricproblem.
So could somebody have constipation and you actually use shybowel?
Like you get in there and you're socontemplating.
You'relike, I gotit. Why should I get like acomment?
As you're like stressing andtensing, you're actually in this almost like traumatic response to pooping because you're so stressed about beingconstipated.
Is this like athing? It's the immediatestress.
But moreso, it is what happenedbefore.
So people who tend to hold their pooin.
So you have to have a bowelmovement.
But there's not a good bathroom or you don't havetime.
You're at the airport and you worry that your flight's going to board without you or you're atschool.
And the bathroom'sgross.
And there's space between thedoor.
And people can see and hear andsmell.
And youknow, there's noise associated withit.
It's one of the most important things for bowel hygiene is to not havestalls.
Because even peoplelike, I am the least shy about bowelmovements.
But Imean, I don't want to have a bowel movement inpublic.
But I don'tcare. I'll be in the stall talking toyou.
That's not reallynormal.
Most people do not want to be in a bathroom with four stalls having a bowelmovement, talking to somebody on the other side of thedoor.
They'relike,no, they wantprivacy.
Having a bathroom where you have a toilet and a door that closes and notstalls, hugely helpful for good bowelhabits.
Because a lot of people will be comfortable going to the bathroom in thatsetting.
So you have these twomuscles.
You have the internalsphincter, which is under involuntarycontrol.
Meaning it's going all thetime.
It'stight. It's tight to preventleakage.
And then you have the externalsphincter, which is under voluntarycontrol.
And that's the one that you open or close depending on whether you're trying to push a stool in orout.
Now, when the rectum fills withstool, the internal sphincter relaxes to let the stoolout.
And that's when your external sphincter is supposed to push itout.
But if youdecide,oh, thisisn't, youknow, I don't like the look of thisbathroom.
I'm going to trainstation.
I'm going towait. You're clenching when you should bereleasing.
And that completely confuses thesphincter.
So you can train yourself to hold it in and not realize you're doingthat.
100%. So that creates something called reverseparasitosis, where the stool is going back up in the wrong direction instead of comingout.
And so if you do that oftenenough, and often this happens inchildren, it's more common ingirls.
We tend to be a little bit more fastidious about where we use abathroom.
If you do that oftenenough, it means that when you actually want to have a bowelmovement, youcan't, because the sphincter isconfused, like the internal sphincterrelaxes.
But now the external sphincter isclenching.
My best advice for people is if you have tried everything for yourconstipation, you did the fiber and the water and this and that and you exercise and you do all these things and nothing isworking, consider some of these mind bodypractices, whether it's cognitive behavioral therapy or it's internalbiofeedback, which is a kind of physicaltherapy, find a biofeedbackpractitioner.
It could make a hugedifference.
And the keys forme, one clue is on the rectalexam.
I'llsay,oh,yeah, this person definitely hasanismus.
And another clue is when somebodysays, I've done all of these things and not only is it notworking, it's making me more bloated because the sphincter at the very bottom istight.
And so all the fiber and the water and everything is all backed up right at the backdoor.
But the door won'topen.
So what isthe, how do you know if you're bloated versus you're just gainingweight?
Yeah, that's a really challenging and sometimes uncomfortable conversation to have withpeople, but a really useful way to know is to take a tape measure and measure right around yourwaist, generally just around your belly button in the morning and atnight, every day for about aweek.
If there is a lot of variation in thatnumber, that's likely bloat because it bloating ebbs and flows and it's usuallygas, but it can also be liquid andsolid.
If it is bellyfat, that number typically won't vary by more than aninch.
And sometimes people come and they have an appleshape, skinnylegs, bigbelly, and they think they'rebloated.
And onexam, I can also tell because fat feelsdifferent.
Yeah. And when you osculate andyou, youknow, you procrastent tap and you osculate andlisten, I can tell fat from fromgas, but if somebody's out there and they're not at thedoctor, measuring the waist and seeing if it ebbs and flows and people send mepictures.
And typicallyit's, it's flat to fat from morning tonight.
So they're flat in themorning.
And then they send me pictures at the end of the day and they're superbloated.
What are some surprising foods that cause bloat that we might not know causebloat?
Yogurt.Yogurt? Yogurt because somewhere between 60 and70% of the world's population is lactoseintolerant.
And some people know it because I have really smelly gas andthey, youknow, it'simmediate, but many of us lose our ability to digest dairy over timebecause, youknow, we're not babycows.
So we're not really the meant to be or designed to be drinkingthis.
The lactase enzyme is along the brush border in the smallintestine.
And if you have an acuteinfection, that can knock it off and you loseit.
And just as we age overtime.
And so people might have tolerated dairy reallywell.
And now they're not or their dairy would mostly be cheese and yogurt and things that don't have as muchlactose.
They're not drinking big cups ofmilk.
But dairy is one that a lot of people think of as a healthfood.
And it can beright. It's fermented food and soon.
But so often people are not tolerating thedairy.
And so they're having all this yogurt everyday.
It's aconvenient,quick,portable, delicious orsubprotein.
So many of mypatients, I'll see some form of dairy either yogurt or cottage cheese or trying to get their protein up everyday.
And we get rid ofthat. Things improve alot.
So that's something to and not foreveryone, but for a lot ofpeople.
It'sdairy. Are there some surprising everyday non food things that can cause you to bebloated?
Yes. Thereare. One of the things to remember withbloating, Imean, we think about the GI tract and elimination and stool and liquid andgas.
But it's also our lymphaticsystem.
And our lymphatic system is like a fluid that bathes ourcells.
And it has to drain and exercises what stimulates lymphaticflow.
So if you're sitting for a longtime, and you may noticeit, just if you're sitting for a longtime, your feetswell.
Yeah. Why do you feedswell?
I don'tknow. Because the venousflow, the veins are occluded because you're sitting and there's pressure on the veins and the lymphatics don't move asmuch.
So moving around exercise really important for lymphaticflow, really important for debloating.
And then there's things like salt in the food alcohol and alcohol is a big one because it irritates thegut.
That can lead toinflammation.
That can lead to fluidretention.
It also dehydratesus. And then that causes fluid to shift andpuffiness, things likethat.
But exercises another big one forbloating.
When somebody comes and seesyou,Dr.
Robin, and they just arereally, reallybloated.
And it's not a big seriousissue.
It is something that they'reexperiencing.
Is there like kind of like a step-by-step protocol that you'relike, do this and dothis.
And you should be feeling relief in a matter ofdays.
I love putting people on a liquid diet for a couple days and using some magnesiumcitrate.
Now, I want to say with the magnesium citrate in theliquid, thebottle, you got to make sure there's no kidney disease and other things goingon.
But let's say this is a typical healthyperson.
They went onvacation. They oversported themselves in the words of mymother-in-law.
They ate a little toomuch.
They drank a little toomuch.
They, youknow, most of us come back fromvacation, feeling a littleconstipated.
Why isit? It's because we've just beenlike,woo-hoo!
It's because we've beenwoo-hoo.
And also if we've crossed timezones, that we often feel jet lag in ourgut, it slowsdown.
And also because our GI tract is a creature ofhabit.
So, youknow, now you're in a strange bathroomsomewhere.
And so our bottles get a little shy when we'retraveling.
So my favorite thing in that situation is to put them on two days of a clear liquiddiet, which could be broth and tea and green juice as opposed tosmoothie.
And do that for a couple days and a little bit of liquid magnesium citrate atnight.
Not toomuch. We don't want to blow upthings.
Holities forthat?No,no,no.
The typical bottle of magnesium citrate is about sodabottle.
So maybe a quarter ofthat.
A quarter ofthat,okay.
So like a cup of the liquid magnesiumcitrate.
Make sure if you haven't takenthat, that you know where the bathroom is because magnesium citrate for somepeople, it will workovernight.
And for somepeople, it could work in a couplehours.
Yeah. So I like that becauseagain, the stimulant laxatives that havesena, things likethat, those are really hard on thecolon.
Colin can becomedependent.
Some of them have an impact on the microbiome that isn'tgreat.
The liquiddiet, youknow, that is a great way to sort ofreset, todecompress.
Most of the time when your colon isuncomfortable, stop eatingliquids.
It worksgreat. And youknow, you see with animals in the wild when they'resick, they stopeating.
You won't see a dog who picked up aparasite, chowing down on theirfood.
Infact, that's often how we know they'resick, like in addition to the fact that we're looking at theirstool, they're noteating.
So that is still reallyhelpful.
What we callNPO, nothingperorum, nothing bymouth.
And it doesn't have to be thatextreme.
But going to liquids and eating less to allow whatever it is to comeout.
And that could betrue, even for something that'sinfectious.
If you have a mild case of infectiousdiarrhea, a foodborneillness, and your GI tract is trying to expel that and you're having diarrhea and you're vomiting and it's trying to eliminateit, don't go adding a whole bunch of food on top ofthat,right?
And make itharder. If your GI tract wants toempty, let itempty, get it all out and then startagain.
So that's my favorite thing is just to do a little minicleanse.
How does stress impact aregood?
Stress has a huge impact on our GItract.
So we talked about the gut brain connection and theneurotransmitters, etcetera.
But stress triggers our sympathetic nervous system and that's our fight orflight.
A parasympathetic nervous system is our chillout, rest anddigest.
So if you think about having to get away from the tiger that's chasingyou, you need the blood flow to go to your brain and the large muscles in yourbody, yourquadriceps, your hamstrings so that you can run and get away fromdanger.
Digestion itself is a very activeprocess.
It takes a lot of enzymaticactivity, a lot of bloodflow.
So when you arestressed, all the resources are diverted away from your GItract.
And so stress can really impact digestion negatively because it will affect not just the way the digestive enzymes aresecreted.
It can decrease acidsecretion, it can decrease other digestive enzymessecretion.
But we know stress can also increase the population of unhealthymicrobes.
There was a famous experiment that was done in college students and it found that duringfinals, certain more pathogenic bacteria could increase a thousand fold in anhour.
Just start multiplying and multiplying andmultiplying.
And you think about when college students are notsleeping, they're not eatingwell, they're over caffeinated and now their microbiome is out ofwax.
So stress has a really profoundimpact.
The question comes up a lot male with people who have irritable bowelsyndrome, particularly folks where there hasn't been one or two more specific causes found and they want to knowwell, is stress causingthis?
What I find in the GI tract is stress isn't usually the entirereason, but it can be a really major contributingfactor.
What are symptoms that indicate that there may be something more serious going on with yourgut,Dr.
Robin? Red flags in the GI tract are really important and those would include things like blood in thestool, weightloss,vomiting, abdominalpain, not like a littlediscomfort, but you know like that reallyhurt.
Those are the things on relentingnausea.
Those are the things that I would say get the to a gastroenterologist and quickly for thosethings.
Dr.Robin, you have this 10-day plan for a better gut and you call it the gut bliss method where you walk us throughit.
Yeah, I call it the gut bliss method and it consists ofremoving, replacing andrestoring.
So the first part is to removefoods,practices, medications that are potentially harmful to yourdiet.
So that would be things like ultra-processfoods,alcohol,non-striol, anti-inflammatorydrugs, and excessiveantibiotics.
And forpractices, it may be something as simple as not taking enough time to have a bowelmovement.
So removing those things and the idea behind that is kind of like thebathtub.
If you're going to fill thebathtub, you got to make sure the stopper isin.
You don't want to be trying to fill a bathtub with a stopper out because you're eatingfoods, taking medications that are still causing aproblem.
So that's yourmove. Replace is trying to add in those extra healthybacteria, not through a probioticprimarily, but through exposure tonature, through fermented foods that we talkedabout, the powerhouse combination of pre-pro andpostbiotics, and those sorts of really healthy high-fi-burn fermented foods to replace the gutbacteria.
And then the restore is how do you restore overallhealth?
And a lot of that focuses on my mind-bodypractices, on gettingoutside, on gettingquiet, reducingstress, and of course hydration is a big part ofit.
So it'ssimple, it's stuff that anybody cando.
It's notexpensive. Imean, you need access to some goodfood, and you need to actually eatit.
But what Ifind, whether I'm seeing a patient who has complicated Crohn's disease or somebody who's just a littlebloated, it is incredible how much of a difference these basic principlesmake.
And I came up with themover, it's been a couple decades ofpractice, and not to say that some of thefans, your things don't play a rolealso,right?
But what I find the majority of thetime, it's really getting people to pay attention to these foundational things that they cando.
These are not things that requiregastroenterologists.
Imean, you may need to go to the gastroenterologist or theevaluation, forsure, particularly if you have alarmsymptoms.
But these are things that anybody can build into their everydayroutine.
And I know thatit, youknow, it doesn't sound supersexy.
Well, where's thefancy, youknow, magical food andsupplement?
But believeme, when I tellyou,Mel, I have done thousands ofcolonoscopy, seen thousands of patients in the 30 plus years since I graduated from medicalschool.
And these are the things that make adifference.
And the beautiful thing is you can see a differencequickly.
You may not be able to reverse your own immune diseasequickly, if that's part of thegoal.
But in terms ofthat, tangible return on investment that your gut is going to giveyou, when you sit down and you have that stool nirvana for the firsttime, and you'relike,damn, is this what it's supposed to feellike?
Like I just detoxed in the most profoundway.
I freaking loveyou. I feel sosmart.
And I literally want to go to thebathroom.
And just like enjoy having apoo.
I would loveDr. Robin for you to talk directly to the person listening because you have been so generous and have poured intous.
There was so much that you taught us that you equipped us to be able todo.
If there was one thing that you really want them to remember that they walk away and that they implementtoday, what would thatbe?
Eat moreplants. Eat moreplants.
You don't have to be vegan or vegetarian or any ofit.
But plant fiber is the most important food for I've gotmicrobiome.
It doesn't mean there are not other things that aren'thelpful.
And it doesn't mean the other stuff you're eating isbad.
But we have to feed ourmicrobiome.
We have to nourish and nurtureit.
And we do that with plantfiber.
Whether it's just a carrot steak as you're going out the door and apple that you throw in your bag or it's morecomplicated, youknow, lentilbowl.
Eat moreplants. Youknow,Dr.
Robin, I often remind everyone that some of the best people that you willmeet, you haven't metyet.
And I just loveyou. I just loveyou.
I literally walked into mylife.
And we are going to be lifelongfriends.
And for therecord, you are already super smart before I walked inhere.
You're already knew so muchstuff.
People need to understand how their bodyworks.
We're kind of alienated from ourbody.
And we're really alienated from ourgut.
We don't even want to look in thetoilet.
I'mlike, how can you not look in thetoilet?
It's like tealeaves. Like it's telling yousomething.
This is really important evidence andfeedback.
Like you can't just flush it and ignoreit.
And we do that because we still have this sort of Victorian sensibility about cleanliness and stool and it'sdirty.
And so really understanding how this stuffworks.
And forme, helping people tounderstand, and this was really the focus of the lastbook, the antiviralgut, thatyes, our gut is a digestive organ and digestion is reallyimportant.
But our gut is also a defensiveorgan.
Stomach acid isn't just there to digestfood.
It also killspathogens.
Our gut lining literally protects us from pathogens so that bacteria and viruses can't penetrate and get into our bloodstream and travel to the rest of ourbody.
Our stool eliminates not just wastematter, buttoxins.
So there's a huge defensive element to ourgut.
And if we want to stayhealthy, we got to keep these defensesgoing.
We got to protect these defenses and understandthem.
So I'm so grateful to have a chance to come on and explain all thisstuff.
I'm so grateful that you'rehere.
And so the person that was listening to us didn't just feelsmarter.
They feltseen. They now understandthemselves.
And moreimportantly, you know what todo.
And you know why this can work and why itmatters.
And that means somebody's going to tryit.
And the simplicity of it is also something that I really love because let's faceit, we're allbusy.
If you can't fit it into your already crazy busylife, you're not doingit.
If you can't remember it when you stop listening to the two ofus, you're not going to be able to doit.
If you can't share it with your friend who has irritable bowel syndrome oryour, youknow, son or daughter or your husband who has a problem withconstipation.
If you can't remember what to tell them and why itmatters, you're not going to be able to helpthem.
Absolutely. And so I so appreciate spending this time withyou.
I would sit next to you in a public bathroom in open stalls and chit chat allday.
And so thankyou. What are your partingwords?
I want people to remember that when they have these symptoms in the GI tract of bloating and constipation andheartburn, so often these are not illnesses that are just falling out of thesky.
This is your gut trying to communicate withyou.
It isknock,knock. In the case ofheartburn, why did you have that poor house stake at 11 o'clock last night and the two glasses are redwine?
You should have that at 1o'clock.
How to solid atnight. So it is your GI tract giving youfeedback.
Why is it giving you feedback to keep youalive, to keep youhealthy, to protectyou, to try and prevent you from doing itagain?
But what do wedo? We don'tlisten.
We just block acid and keep ongoing.
Now thereare, ofcourse, these alarmsigns, right blood and severe pain and soon.
But most of thesymptoms, a commonsymptoms,indigestion, theconstipation, thebloat, thesethings.
It is your GI tract sayingknock, knock and trying to communicate withyou.
And my whole goal is to translate thestuff, to basically teach people gutlanguage.
Let me tell you what your GI tract is saying and how you canrespond.
And once people dothat, they don't needme.
And that's agoal,right?
I'm superflawless. I'll just see what the farm ismarket.
Hey, what'sup? Or a publicbathroom.
You shouldnot, if somebody is continuing to come and see me year after year afteryear, aside from chronic autoimmunediseases, it means I'mfailing.
I'm not doing myjob. If I were seeing you for constipation 10 years ago and you're stillconstipated, you should fire me because I needed to have given you thetools.
I need to have translated for you so that you now speak gut ease and you understand and you know exactly what todo.
Dr.Robin, thankyou, thankyou, thankyou, and thank you for tuning in for sharingthis.
I know you're going to share this with so many people in yourlife.
Didn't you freaking loveher?
And for therecord, I would be next to you in a public bathroom stalltoo, talking off my like whatever with you because I loveyou, I believe inyou.
And what I'm so excited about is you now have world class medical facts and understanding from literally the number one expert onthis.
So you can empower yourself from the inside out to activate the natural intelligence of your body and you now know all the health implications and how positive itis.
So go doit, share this episode please and I can't wait to see you againsoon.
Andthree,two, oneaction.
I love it when she saysthat.
I already feel like you're my new bestfriend.
I already feel like you're my new bestfriend.
I'm100% okay because we're going to talk for like five fucking out offive.
Yes,sympathetic, restaurantdigest.
Yes.Yes. Ohwow. Starting today that will helpyou.
Oh mygod,sorry. Ohshit.
Okay, I gotta go backup.
I didn't realize that wasokay.
So you're fuckingamazing.
Oh mygod. Youguys.Wow.
Oh, and one morething. Andno, this is not ablooper.
This is the legallanguage.
Youknow, what the lawyer's right and what I need to read toyou.
This podcast is presented solely for educational and entertainmentpurposes.
I'm just yourfriend. I am not a licensed therapist and this podcast is not intended as a substitute for the advice of aphysician, professionalcoach,psychotherapist, or other qualifiedprofessional.
Gotit?Good. I'll see you in the nextepisode.
