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Hello, this is Chris Duffy, host of How to Be a Better Human. This week, instead of an episode of our show, we are going to play you an episode from one of our podcast siblings, another show from the TED Audio Collective, Body Stuff with Jen Gunter. This is a fantastic new podcast that's coming out, and we think you'll really like it, which is why we're going to play an episode of it.
on our feed here. And if you do, you can subscribe to Body Stuff with Jen Gunter and check out more episodes like that. We did the same thing a couple of weeks ago with an episode of Work Life with Adam Grant. And we'll be periodically showing off other podcasts in the podcast family. I hope that you enjoy and we will be back with a new episode of How to Be a Better Human next week.
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These days we're surrounded by photo editing programs. Have you ever wondered what something or someone actually looks like under all the manipulation? I'm Elise Hugh and you might know me as the host of TED Talks Daily. This October, I am giving a TED Talk in Atlanta about finding true beauty in a sea of artificial images.
I'm so excited to share the stage with all the amazing speakers of the TED Next conference, and I hope you'll come and experience it with me. Visit go.ted.com slash TED Next to get your pass today. When we're kids, we have a beautiful gift. Why does poop smell bad? Because of its things inside. Yeah, like poop.
Diseases and... It's diseases. We can talk freely and happily about something we all make. Poop. I've had red poop and green poop. But when we get older, all that laughter turns into embarrassment. So when we have questions or concerns about our poop...
We often let those questions fester and myths can seep into the gaps left by unanswered questions.
Myths prevent you from having a real understanding of how your body works. They can leave you vulnerable to bad advice, worrying about things you don't need to worry about, and even missing real problems. Today, we're taking on poop and the digestive system. Look, there's nothing shameful about your body, not one part of it, and it's healthy to talk about it and to learn about it.
I'm Dr. Jen Gunter. From the TED Audio Collective, this is Body Stuff. There's one myth I hear all the time that you have to poop once a day. Otherwise, you're constipated and something is wrong and something bad might happen to you. But there is no magic number for number two.
Everyone is different. Anywhere between three bowel movements a day to three a week is typical. There are a lot of other poop myths out there too, and they thrive and are shame and embarrassment. And one way to clear them up is to get comfortable talking about poop. My father in particular was always very open and
I would say overly enthusiastic about discussing bowel habits at the dinner table. That's really interesting because I got into gynecology probably for the exact reverse. My mother was the biggest prude in the whole world, and we never ever talked about anything sexual at all. We all have our different inspirations. I know, right? Inspiration can come from anywhere.
Dr. Anish Sheth is a gastroenterologist, a specialist in everything from your esophagus to your stomach to your intestines, and he's building on the family tradition. He wrote a book called What's Your Poo Telling You? Dr. Sheth says there are a lot of fascinating things to learn about your poop.
Like one reason why coffee might get things moving. It's actually something called chlorogenic acid, which is a component of coffee, which itself stimulates the movement of the intestinal tract. And what it takes to achieve something called puphoria.
It's something that if we could bottle, I think would be a good thing for humanity. There are also mysteries about our gut, things we're just starting to understand. Like the fact that your gastrointestinal tract has over 100 million nerve cells. Sometimes it's even known as the second brain.
And serotonin, a neurotransmitter that affects our moods, isn't just found in our brains. Serotonin is actually found in higher concentrations in our gut than in our central nervous system. So it is quite complex, and I think we're just scratching the surface of understanding it. Let's start our journey to Poo-phoria with the basics. Poop is a waste product. It's the end result of the digestive process.
It's mostly water, but it's also made up of fiber, some dead cells from the lining of our intestines, mucus, and bacteria.
Some of the bacteria release stinky gases, like hydrogen sulfide, which you might know as sulfur, giving poop its characteristic aroma. These are things that are byproducts of the food that we eat, the digestive process, things that we no longer really need. And so the body very efficiently and maybe elegantly gets rid of it. And that's what we call stool or bowel movements.
Things can go wrong in the digestive process, and that can cause a lot of pain, discomfort, and suffering.
Because people are often squeamish talking about their bowel movements, they don't always bring up these concerns with a doctor. One survey of Americans with the gastrointestinal condition irritable bowel syndrome found that 67% of them waited more than a year after the start of their symptoms to even talk to a doctor. As a gastroenterologist, it's a little bit disheartening because you sort of feel like, you know what, this person unnecessarily suffered
when we could have intervened earlier and maybe things would be better than they are now. And it just sort of speaks to the stigma sometimes people feel that exists around things related to your gut. And when people do bring up their concerns, you know what?
they're often dismissed. A report from the United Kingdom found that a third of people with the bowel disorders, irritable bowel syndrome, and inflammatory bowel disease had to visit their doctor more than five times to get a diagnosis. So today we're talking about our poop and what we can learn from it. But we're starting with something I've always wondered about.
What's the origin of this shame? Look, we love to blame the Victorians for everything, for all of our weird hangups. Dr. Barbara Penner is an architectural historian. She wrote a book called Bathroom. It's about how toilet design and our ideas about poop have shaped each other over the centuries. Dr. Penner took me back to a time in England when most people didn't use indoor toilets.
Those were only for the very, very rich, darling. Instead, most people used outhouses.
If we look at pre-modern times, let's say pre-18th century, there are loads of examples of two- and three-seater outhouses. Seats for people to poop side by side. And these really remind us that there just was not the same sense of shame around bodily functions.
And we know that for many people, going to the toilet could even be a time for socializing. That's awesome. Imagine pooping next to your best friend or your mom or your neighbor. Instead of sitting on the stoop catching up, people were sitting on the toilet chatting. It's where you caught the local gossip.
And that was totally normal until the 19th century, the Victorian era in England. That's when indoor plumbing became much more available in England and the U.S. And it's when we learned more about how diseases spread.
the British became obsessed with sanitation. The Victorians surely must go down in history as some of the greatest cleaner-uppers of all time. They zealously pursued sanitary reform. They constructed infrastructural projects like London's sewer system. But for the Victorians, Penner says,
It was about more than just hygiene. It became almost a moral imperative to distance oneself from sources of dirt or contagion. And the body itself became deeply shameful. All that Victorian shame even affected where women could use the bathroom.
Proper women weren't supposed to just sit there, delicate bottoms down and poop anywhere. It was quite common to hear female public conveniences described as abominations. The people who actually needed female public conveniences were
were female factory workers who were often commuting to and from their jobs. Right. So it's a clash of classism and misogyny. Definitely. According to Dr. Penner, the Victorians also popularized the actual physical bathroom design many people in the West are familiar with, a flushable porcelain throne that you sit on in a small, isolated room.
This was called a water closet. Remember, we're talking about the British Empire here. And at this time, it was huge and reached around the globe. So you find British-made sanitary systems
all around the world by the end of the 19th century, early 20th century, and water closet became a symbol of civility. The absence of a water closet meant that you could very easily stigmatize people who went without as being inferior people.
So when these first, you know, Victorian water closets came out, did people have toilet paper? What did they use to wipe their bottoms? They used strips of paper. This was also very conveniently the age of the mass produced newspaper.
Maybe that's why reading on the toilet became a thing. Anyway, Dr. Penner says the water closet took off, not because it's designed based on human physiology or science, but because it was championed by the most powerful empire in the world at the time. And when the British Empire spread its new invention, it also spread cultural ideas of poop shame.
But the British porcelain throne design is not universal. It's based on sitting when we poop, but our bodies actually perform best when we squat. We'll get into this more later. It's important to point out that in many countries, toilets are actually made for you to squat rather than sit.
Some places have adapted the British design. Like in Japan, toilets can be totally deluxe with heated seats and little songs that play while you go to cover up any noises you might make. And of course, there are bidets. You find bidets in bathrooms all over Europe, the Middle East, and Africa. After you go, use the bidet to spray off instead of toilet paper.
And then there are the toilets you often find in Germany. They have a ledge so that poo does not fall straight into water, but rather it rests on this ledge and you can inspect it to make sure that you're having healthy stools. That's a literal inspector gadget. ♪
After the break, what looking at your poop, like some Germans do, can teach you. Look before you flush. A lot of people just take care of business and they'll flush. And I think they're flushing away real good information about their health.
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I want to tell you about a new podcast from NPR called Wild Card. You know, I am generally not the biggest fan of celebrity interview shows because they kind of feel packaged like they've already told these stories a bunch of times before. But Wild Card is totally different because the conversation is decided by the celebrity picking a random card from a deck of conversation starters. And since even the host, Rachel Martin, doesn't know what they're going to
pick, the conversations feel alive and exciting and dangerous in a way because they're vulnerable and unpredictable. And it is so much more interesting than these stock answers that the celebrities tend to give on other shows. You get to hear things like Jack Antonov describe why boredom works or Jenny Slate on salad dressing or Issa Rae on the secret to creativity. It is a beautiful, interesting show, and I love it. Wildcard comes out every Thursday from NPR. You can listen wherever you get your podcasts.
So now you know poop is a waste product, but you may wonder how it's made. Let's take a closer look at your digestive tract. The digestive system is the long winding tube that runs from your mouth all the way down to your anus, plus a few extra organs that provide essential assists along the way. The digestive process starts when we eat something. We chew the food and our saliva softens it and starts to break it down.
The food goes down to our esophagus, then into our stomach. It's here that the pieces of food are made smaller with acid and enzymes. And then those smaller pieces are then emptied into the small intestine. The small intestine, its job is to absorb the nutrients from the food. It basically sucks up the good stuff that we need. And the leftovers go to the large intestine. Here's our gastroenterologist, Dr. Sheth, again.
And so by the time this sort of debris, if you will, gets to the large intestine, which is also known as the colon, really all the absorption of nutrients has taken place. So then we're just left with sort of the waste products, the byproducts of all this stuff. The stuff from the small intestine is pretty liquidy at this point. So the colon starts absorbing the water and packaging what's left over into stool. And then it sends it on down to the rectum.
Another amazing thing about the colon, it contains trillions of bacteria. This is the microbiome that you might have heard about. A good analogy is a rainforest where a lot of different species coexist and contribute to maintaining a healthy ecosystem. It's just in this case, it's bacteria creating a good environment for the gut.
The bacteria in our colon help with digestion. They also actually produce vitamins, like several of the B vitamins and vitamin K.
And they seem to do a lot of other stuff that we don't totally understand yet. They may play a role in obesity. They may play a role in heart disease, even mood, like things like depression. And I think this is really the most exciting aspect of gut health is that the bacteria have evolved with us for, you know, tens of thousands of years.
And what we used to just think of as sort of maybe innocent bystanders, maybe causing harm, now we actually realize they actually may have beneficial effects that not only to our GI health, but also to our overall health. I hear a lot about hacking your microbiome by taking probiotics, but we really don't know enough about the microbiome to understand how to do something like that.
What we do know is that if you sample the microbiome and characterize somebody's balance of bacteria and what types of bacteria they have, you'll see some things that cluster with certain conditions in people that have better overall health. You will see some things that are different in their bacterial profile. What we don't know is if I take some healthy bacteria by mouth and if I can change this balance of bacteria,
will it then have beneficial effects on my metabolism, for instance? And I think that's really where we haven't been able to show that. And I think in general, I think you probably realize as well that sometimes when things seem very simple and easy in medicine, it turns out like it's not the case. Such a complex subject that we don't know what we don't know about the microbiome. It's like a whole new world and we've just scratched the surface.
But one thing we do know about is how to poo, the fine art of defecation. Defecation is releasing poop from your body and it's actually a very coordinated, elegant process. The stool created by the colon makes its way to the rectum, a pouch right at the end of the large intestine. In the rectum, the stool builds and builds until it reaches a certain amount.
That's when the rectum sends a trigger to your brain that says, "Hey, pouch is getting full. Maybe we need to empty this." So your brain makes an assessment. Is this a socially acceptable time for me to poo? Or maybe not.
Once your brain has assessed it's a socially appropriate time, the muscles around the rectum and the anus relax and release the stool. If it's not a good time, your brain sends signals telling your rectum to calm down, kind of like your rectum says, are we there yet? And your brain's like, nope, nope, not yet, not yet. Occupy yourself with something else.
The anal sphincter is an especially amazing part of this process. It's a complex made of two muscles, the internal and the external anal sphincter. The anal sphincter has a ton of nerve endings, so it can detect the difference between gas and poop and communicate that information accurately to your brain. And the lining of your anus, the muscles in your brain are all doing this amazing communication
completely behind the scenes. The whole digestive process can take between 24 to 120 hours in healthy people. And because poop is a waste product, it has to leave your body. You've probably experienced how unpleasant it is when it doesn't. Constipation is a common poop problem.
To help people understand what's going on when you're constipated, I like to use an analogy of a tennis ball and a pantyhose. Think of your poop as the tennis ball and your colon as the pantyhose. Constipation happens when the tennis ball doesn't get from one end of the pantyhose to the other like it should.
It could be moving too slowly, causing you to poop infrequently, or your poop could be hard and pebbly like a rock is trying to get through instead of a tennis ball. Or both of these things could be happening at the same time. Constipation can also be caused by tight muscles in the pelvic floor that won't relax enough around the rectum for you to release the poop.
There are a variety of treatments for constipation, and what treatment you might need depends on the cause. Some examples are eating more fiber, taking laxatives, or even seeing a specialized physical therapist who can work on those pelvic floor muscles.
We have a lot of good treatments for constipation, but unfortunately, there's a lot of bad advice online. For example, drinking more water isn't a treatment for constipation.
And there are fake constipation cures you need to avoid, like colon cleanses, special supplements, teas, pills, coffee enemas. That means literally injecting coffee into your rectum. It belongs in your cup. These are marketed all over the internet as things that will flush out toxins and waste from your colon. It's predatory quackery.
It's absolutely not needed. And it's actually potentially harmful because we talked about the benefits of the bacteria that are in our large intestine. And so when you go through this kind of cleanse on a regular basis, you are wiping out the good bacteria and you're changing the balance of the bacteria in your system. Once you defecate and poop comes out, there's a lot you can learn from looking at it.
What can we learn about the texture of poo? Texture when it's soft, consistent, you know, not overly viscous and thick is really a sign of a good balanced diet. So in your book, you write about different kinds of poo.
So what's a monster poo? Monster poo just means you're just having a large, huge bowel movement. When you have a monster poo, you can experience this sort of sense of joy and elation that we call poo-phoria, right? It comes from sort of distending the rectum, which we talked about as being a very sensitive area, and then having it decompress sort of in a single bolus stool as it comes out. And that sometimes just makes us feel great, like...
You want to high five the first person you see when you come out of the toilet. That's pretty funny. And it's always good to have some well-placed humor about our bodies.
But it's also important for us to recognize that our poo can give us signs that something is seriously wrong with our colon. If you see blood in the stool, you always should call your doctor. That's number one. But the second thing is really a sustained change in bowel habits, right? And that can run the gamut, right? So that can be consistency. It can be frequency, color, maybe even color.
If it happens for a day or two, it's not a concern. But if you notice that, say, you're always somebody who went to the bathroom twice a day, and now for the past, say, several weeks or a month, you're struggling to go twice a week, for instance. Any sustained change that doesn't have an obvious explanation should also be followed by a phone call or a visit to your primary care doctor or gastroenterologist. And I think if you keep those two things in mind,
I think that really covers the spectrum and most of the serious conditions that we worry about in the gut. Colon cancer screening is also important. The latest guidelines in the U.S. are that once you hit age 45, you should talk with your doctor about getting screened. If you have a family history or other risk factors, you may want to talk with your doctor about whether you should be screened sooner.
There are two things that can really help you on your journey to Poo-phoria. First, and this might sound strange to you, actually learning how to poop. Welcome to Pooping 101. Everything you need to know but had no idea you should be asking. Tip number one.
Try not to sit on the toilet for a long period of time. This can disrupt the reflex for going to the bathroom. And when people sit for long periods of time, they might be tempted to strain, which you want to avoid because it can lead to hemorrhoids, which are swollen veins in your rectum. Hemorrhoids can be incredibly painful and really hard to treat. So prevention is key.
I tell my patients is, look, if you have the urge to go, you should be able to evacuate in about five minutes or less. And if you haven't, you need to get up, walk around, do something else. And if you feel like you have to go again, that's still a better option than spending 30 minutes on the toilet. Tip number two.
If you've had a bowel movement and you're not sure if enough came out and you're trying to resist the urge to strain, you can do some quick flicks, which you might have heard called Kegel exercises. That means contracting your pelvic floor quickly. So you do quick, quick, quick, three quick contractions that either push the stool back up into the rectum or push it back out and can take away the urge to strain for some people. Tip number three.
You can also improve your pooping position. The ideal way to poop biomechanically is actually squatting because it opens up the pelvic floor and helps the muscles relax. Most Western toilets aren't designed for you to squat. So to mimic squatting, you can put a stool under your feet to elevate them a little, or you can bend over and grab your ankles.
Don't grip hard though. This is sort of a spa relaxation grabbing of your ankles. Tip number four, try not to wipe aggressively. You need to blot and go. A bidet is also a fantastic option and you can even make a homemade hack with a squirt bottle. The other big tip for your poo-phoria journey is to eat something truly heavenly.
Fiber. I'm a fiber evangelist. Fiber increases the weight and size of your stool and softens it, which makes it easier for it to travel along the colon and less scratchy on the way out.
The classic low-fiber diet causes this sort of what we call pebble poo, right? These sort of small little particles that are like resting on the bottom of the toilet. That's not very satisfying, right? So the opposite of that is when you can eliminate stool in a single piece, and that's usually in somebody who's eating a lot of fiber. If you're eating insoluble fiber, which is one kind of fiber, you
you might notice something about your poop. - We use this term in our book, deja-poo, which is this sort of notion that you're seeing remnants of food that you have eaten in the stool. So there are certain fibers that are insoluble. And I've had many patients come in and say, "I think something's wrong with my digestion." But in reality, they just have a diet that's very high in soluble fiber.
And that's actually a good thing. And there's actually nothing wrong with your digestive tract when you see things like corn kernels, for instance, in your bowel movement. Some types of fiber are also prebiotics, which basically means they're food or fertilizer for the healthy bacteria that live in your gut. If your microbiome is your lawn, then the fertilizer would be sort of healthy diet high in prebiotics.
Fiber has a lot of other benefits too. It lowers the risk of heart disease, diabetes, and certain cancers. But sadly, most Americans don't eat enough fiber. So to rough up your diet, look for high fiber cereals, whole grains, beans, and fruits and vegetables. There's only one downside to eating too much fiber.
I have patients who come in and they go, "Oh my God, I feel bloated. I got so much gas." And then I go through their diet and I'm like, "You're eating 50 grams of fiber a day." So the downside, the only downside in my book of fiber is that it just naturally by the way it's digested will produce a lot of gas. So my friends, fiber is tip number two for your journey to Puforia. This concludes our sweeping saga of poop,
from the mouth to the anus, from Victorians to modern day time. When most people think about poop, they think about shame and embarrassment. It's something they don't want to talk about. And that prevents us from learning things that can keep us healthy. So let's start talking about bowel movements like Dr. Chef's dad did and like Rosie and Wilder. What happens when you don't poop? It's impossible. You can't not poop. And please, while we're talking,
Think about eating a little bit more fiber. Next week on Body Stuff, you didn't learn about this in health class. And what you have heard about sounds like a horror movie, but actually it's a marvel. There's so much positivity at that stage of life.
You, the person, are so complete at that phase of life. You lose some, you gain more. We talk about what menopause really is and why your grandma is even more amazing than you thought. So get the health education you missed right here. Body Stuff is a member of the TED Audio Collective. It's hosted by me, Dr. Jen Gunter, and brought to you by TED and Transmitter Media.
This episode was produced by Camille Peterson and edited by Sarah Nix and Lacey Roberts. The rest of the team includes Alice Wilder, Greta Cohn, Michelle Quint, Banban Chang, and Roxanne Highlash. Alex Overington is our sound designer and mix engineer. Christiana Parda and Nirja Aravindan are our fact checkers. And special thanks to the person who invented heated toilet seats.
We're back next week with more Body Stuff. Make sure you follow Body Stuff in your favorite podcast app so you get every episode delivered straight to your device. And leave us a review. We love hearing from our listeners. See you next week.
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