The science of gut health – Trisha Pasricha

Trisha Pasricha (0:00)

We've seen in human studies that certain foods are processed by your microbes in a way that they can make depressive symptoms worse and make them better. Like for example, citrus foods have been shown to boost mood. Anytime somebody is like, well, what is the best diet for me for this? Like it's actually like, there's a very like simple, really boring set of eating patterns, behaviors that are beneficial for almost every single disease out there.

Kai (0:25)

Today's guest is Dr. Trisha Pasricha, a physician researcher who specializes in gastroenterology. Trisha is an assistant professor at Harvard Medical School, a practicing gastroenterologist at Beth Israel Deaconess Medical Center, the director of the Institute for Gut Brain Research, and the Ask a Doctor columnist for the Washington Post. Her new book is called, You've Been Pooping All Wrong, How to Make Your Bowel Movements a Joy. Trisha, thank you so much for being here today. I'm really excited about this conversation. I want to say that reading your book was a joy. It manages to be both deeply serious and genuinely funny, which feels like exactly the right combination for a book about this subject.

Trisha Pasricha (1:10)

Thank you.

Kai (1:11)

On one page, you're citing research from the New England Journal of Medicine, and then maybe on the same page, you're cracking a hilarious fart joke.

Trisha Pasricha (1:21)

You can't write this kind of book without cracking a few poop jokes in there.

Kai (1:25)

Obviously, you have the gravitas or the authority to write such a book, which I feel like you need. There are obvious cultural taboos against talking too openly about the bowels. Because of that, we don't discuss them nearly enough relative to their actual importance in our daily lives. You open the book with an anecdote about highly educated patients coming to your clinic with these debilitating gut problems, but they're so embarrassed, they can barely describe their symptoms, and one of them is shocked by the idea that he would even like look at his own stool. So my first question is, what drew you to gastroenterology in the first place, and how did you develop this passion for understanding and talking openly about the human digestive system?

Trisha Pasricha (2:08)

I was inoculated really early, so my father is a gastroenterologist, and he is not just a regular gastroenterologist, but he was one of the first neuro-gastroenterologists, which is a subspecialty within GI that studies the gut brain connection. And I grew up with this father, who was so fascinated by everything that he did in that field. He went on to become a big sort of researcher, and he opened up a lab that was funded by the NIH. And the way he looked at the bowels and talked about our guts, which was like every day, was never in this like embarrassed behind closed doors, like we need to keep this like for decent society. Like he was never like that, like he just talked about it like as it was this normal subject, because it was part of our bodies and he wasn't ashamed of it. And like we which shouldn't be, shouldn't feel ashamed of it. And that's how I grew up thinking about it. And I also watched, I've never seen anybody who is as excited and passionate about their jobs as my own father. Like he, the research part of it really caught hold of something like deep inside of him. And every time he had an exciting discovery that he'd found in the lab, like he told us all about it. He got us really excited about it too.

And so by the time I showed up into medical training, like I thought I always wanted to do gastroenterology. But it is true that when I became like my own independent practicing physician on my own, I would say the words that I had learned, I'd become trained to say in medical training, which was like, well, tell me about your bowel movements. Well, how many bowel movements are you having a day? And it wasn't getting me as far as I wanted. Like patients were uncomfortable coming into my clinic. A lot of them were already so embarrassed. It was hard. I'm a younger female physician. A lot of the patients just didn't feel like I was the right person to talk to about their poop. And then I was using this language that, and granted, and then there was a lot of the other patients thought I was the exact right person. But sometimes using that language that was really formal, really medical, stopped people from saying what they wanted to say. And we treated it like this, like, weird identity. So one day I was like, let me just try this experiment where I just say, like, what does your poop look like? And I did that once just to, like, see what would happen to this person. And it was like the very first time the entire clinic was that they smiled and they laughed. And I was like, whoa. And then the rest of it, they were like, oh, well, you know, like, this is, it's tough. I hardly poop at all. Like a week goes by and I don't. And then suddenly I was able to have like this real conversation and get to the bottom of things, no pun intended, which I would have never gotten that relationship with them, and built that trust if I had just stayed like really uncomfortable myself and like not use that language. Granted, there are some people who would rather die than say the word poop. And that's fine. I try to read the room, you know, but like if somebody leads with a word that they want to use, like, frankly, the word doesn't matter to me. I just want people to feel comfortable. But I have found that if I seem really comfortable using whatever language people are using in real life, then people feel more comfortable to like actually talk about it rather than speak of it as this, like, you know, like highly intellectual entity out there in the world that we're not actually both doing, hopefully, at least every day.