Can you trust your gut? with GI doctor Trisha Pasricha

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1:44But if you jump to label it too quickly, I think we can get this entirely backwards. Hey, everyone. It's Adam Grant. Welcome back to Rethinking, my podcast with Ted on the science of what makes us tick. I'm an organizational psychologist, and I'm taking you inside the minds of fascinating people to explore new thoughts and new ways of thinking.

2:09Trisha Posricha is a gastroenterologist at Harvard, and the writer behind the Washington Post's Ask a Doctor column. She's been interested in the gut since she was a teenager. Now she has a new book out called You've Been Pooping All Wrong. I have to admit, this isn't the kind of topic we usually cover on this show. Patricia and I had a fascinating conversation about the brain-gut connection, understanding what butterflies in your stomach might actually mean, and yes, some things you didn't know you wanted to know about bowel movements.

2:43So this is an unusual conversation for us and definitely for me. And I can't believe that we're doing it without children present because this is a topic that every kid loves. But I think there are some things that I need to rethink based on this conversation. So let me just ask you to start at the top, Tricia. Where does digestion actually begin? I've always thought about it as something that happens in the gut via the mouth. Yeah, I think that's how most people think about it. But digestion begins in the brain. And we've known that digestion begins in the brain for a very long time. and in a way the gut is unlike so many other organs that our brain and our thoughts and our feelings can so strongly influence what our gut is doing there's almost no other organ where the main thing one of the main things it does can be completely controlled by your thoughts right like your heart is going to keep on beating you might think about a scary movie and you can kind of get it to ramp up but it's not going to fundamentally change what it does whereas like right now if you and I picture this like nice warm gooey chocolate cake and you can picture that chocolate sliding down the plate like soon you might start salivating and actually your pancreas is going to start secreting insulin and your whole gut starts to rev up purely because of your thoughts and that is something that we had observed even as far back as like Ivan Pavlov and that famous experiment with his dogs but it really is those set of experiments that birth this whole field called neurogastroenterology, which is the study of the gut-brain connection.

4:20And that's what I study, and that's what I am now. And it's an exciting field because we now know how deep that connection is between the gut and the brain. Okay, so this bothers me as a psychologist because whenever people say, trust your gut, I have a few reactions. The first one is, no, test your gut because I don't know where you got your gut instincts and whether they're valid in the situation you're in or not. But secondly, I prefer to trust my brain. That's where I do my cognitive processing. And I'm afraid you're going to tell me it's a little more complicated than that. Well, I'm with you that I don't necessarily jump to trust my gut either, which may also be surprising as a gastroenterologist.

5:01I'm sure all my GI colleagues are like, how dare she? The gut is the superior organ. And, you know, let me just say that I think what we consider to be gut feelings in pop culture has taken on almost like a role of like an oracle. Like your gut can predict the future, can tell you the way things really are in a way that your brain may not be able to tell you. And this is something I've studied really, really closely for more than 20 years. And a gut feeling has a true physiological basis. And this is something that I studied when I was in high school. and I developed a lie detector that could use your stomach to detect when somebody's telling the truth versus telling a lie and physiologically what I found is actually a little bit boring and a little bit simple and that is this your gut actually contracts at a predictable cycle just the way your heart contracts at around 60 beats per minute give or take is for your heart for your stomach it's about three cycles per minute and when you tell a lie that cycle gets completely disrupted.

6:07It goes into this chaotic rhythm called arrhythmia. And physiologically, that rhythm and that rhythm disturbance, which starts in the brain, is being driven by this molecule called corticotrophin-releasing hormones. And it comes through the bloodstream and it immediately tells your stomach to halt and stops it from emptying. And if you think about it that way, what's cool is that it means that your gut is often quickly responding to some change, some threat, some excitement that your amygdala is processing, sometimes maybe before your conscious brain in your head has pieced together why. And so your stomach can be this first herald of like, wait, there's something off about this environment.

6:52It can be like, for example, I used to be a theater kid, if I blew my lines on stage, I would get this like sinking feeling in the pit of my stomach, right? Or maybe it's butterflies and you're on a date. We know, we all intuitively know what I'm talking about when we talk about that gut kind of feeling. I think the way we get it wrong though, is that we take that gut feeling and then we assign some value to it. And I usually tell people like, if we just think about what is happening physiologically, that change in your gut's rhythm, which is giving you that gut feeling, that true gut feeling, it's not an oracle.

7:24It's just a message. And that message is just that you need to slow down. You shouldn't act on it immediately, but just think, what is it about my environment that my conscious brain may not have perceived yet, but that I understand? I love that. I mean, that's a really elegant physiological explanation of why I don't want people to blindly trust their gut instincts. Because you're right, there is a message, but the message has to be deciphered. Yeah, exactly. And it has to be translated in the context of everything you know. I mean, The amygdala, I think, in popular science, it gets a little bit dumbed down into saying, like, oh, this is the fear processing hub.

7:59And it's really like a more of an emotional processing hub. And sometimes what you're reacting to is not some fear or some deep-feated concern, but it actually might just be the novelty of a situation that you're not used to. And then conversely, I've seen the other thing happen, and this is very classic. You say you go on a date and you're with someone new, and then you don't get that butterflies in your stomach with that person, you know? And then I've had girlfriends come to me and be like, oh, we didn't have that spark. My gut was telling me I didn't have it. And sure, maybe this person is not the right person for you.

8:31Very valid. However, I don't think you should make that decision based on whether you had butterflies in your stomach, whether you had a gut feeling about it right then and there, without understanding the bigger context of why. because maybe you didn't have that gut feeling because again, physiologically, there was nothing unsettling about this experience. Like it might've actually just been a person with whom you felt very safe and comfortable. Is that such a bad thing? You know, and I think maybe you need another date or two to know, is he really boring or is he really just like a nice person that you feel happy with?

8:58And your next date should be structured more like the bachelor or bachelorette. You're going bungee jumping, right? Obviously. God, only, if only. This reminds me of something that happened in grad school. I invited a bunch of people to, I think it was a Valentine's Day gathering. Nice. Bold. Afterward, one of the attendees gave me feedback that a guy there had creeped her out. Oh, gosh. And I was surprised and disappointed. And I asked her why. And she said, you know, I can't locate it, but there was something about his eyes that just gave me a bad feeling. I knew I couldn't trust him. And I said, you know he's gay, right?

9:38and she was shocked because she thought he was hitting on every woman there. And it turned out that there was something about his eyes that reminded her of a creepy guy that she'd known. And the dots hadn't connected until that moment. Oh, that is a classic example. And obviously, you know, they weren't meant for each other anyway, but like, goodness, that is exactly what can happen. I think when we just, we jumped to a conclusion. Yeah. You know, it's interesting to me when we talk about the role of the gut in decision-making. I just want to build on your oracle observation a little bit. Why do you think people are so eager to trust their gut?

10:18Yeah, I think it's for a couple reasons. Like, one, it is the first place that we respond emotionally in a lot of places. And that's something that we've known intuitively since we were kids. Like, children, when they're feeling sick or where they're feeling nervous, they feel it in their stomach. They'll say, I have a tummy ache. That's often the first place. And that, again, very physiologically valid. We know how stress, how different kinds of emotional triggers can cause these real changes. And so it does feel like you might put this all together and say, yeah, my gut is this oracle. It knows.

10:50And I also think that in some ways the gut is a little mysterious, right? And I do love it for that. And I think the more I learn about the gut, the more I know we don't know. But historically, people have thought that the gut, this was Hippocrates who said, all disease begins in the gut. A lot of people think that a lot of our problems in health and in life can begin and end in the gut. So it does take on this meaning greater than the organ that it is. And again, I'm not downplaying the gut. I'm on team gut here. But I think that there is a lot of misunderstanding and maybe even oversimplification about what the gut does.

11:24Yeah, that resonates. And I wonder if there's also a memory bias at play here where it really eats at us when we had a bad gut feeling about something and we ignored it. Whereas— No pun intended. No pun intended. I mean, I think it's unforgettable when you have this gut instinct, do not trust this person. And then they end up screwing you over because you didn't listen to your gut or interrogate where is that feeling coming from. And that sends a very strong message to change the next time. But the message is not I should always trust my gut. It's that I should do something with that information as opposed to just disregarding it, as we were talking about a moment ago.

12:05And I wonder if the times when we trust our gut and things don't work out are more easily dismissed or don't stick out in our memory as much. This is human nature. We're always going to remember a little bit of the times we got burned more than, I think, a little bit of like the factors surrounding how we ended up as happy as we did. You know, like when they do these studies, they look back and they say like, yeah, people tend to remember the past with a rosier lens. And that's often the case. But I think when it comes to moments of trauma, trauma can really reshape and rewire us, especially if that trauma occurs earlier on in our lives.

12:41The other piece of this that I'm curious about is there's this seductive appeal of, well, I don't have to do the analysis. I don't have to reason my way through this decision because my body will know and it will tell me. Yeah, you're getting this immediate feedback in the moment. And I do think that what is causing that physiologic change in the gut that changed the electrical rhythm, it's often discomfort. And again, I often tell people discomfort is not inherently bad. Sometimes what pushes you, what makes you uncomfortable can be an incredibly good thing. It can be a really good challenge.

13:15and just reframing that feeling of discomfort being bad to discomfort is novel. Discomfort is why do I feel this way can really open up your mind to say like maybe what I'm experiencing right now is not a bad sign. There's actually no prior memory that is resembling this moment, but I'm adding that layer on and I'm imagining that and putting all of this stuff that's actually not there. Yep. I think that tracks. It reminds me of a paper by Eric Dane and Mike Pratt. They study gut feelings in terms of intuitions. And they look at whether you can trust your intuition or not when you're making decisions and predictions.

13:53And it turns out you can if you're either an expert or somebody with a lot of experience in a predictable domain. So if you, for example, are an avid shopper, you can trust your gut about whether a handbag is counterfeit or not. Whereas if you're a novice, you can because you don't have the years of experience in forming that subconscious pattern recognition process. But a lot of our decisions aren't like that. A lot of our gut feelings happen in domains where we don't have a lot of experience or there's not a stable pattern. And that's where I just want people to question, like, what is this signal coming from?

14:33And am I just uncomfortable because I'm in an unfamiliar environment? I often find that people put a lot of value on gut feelings during big life moments for which like none of us have a ton of experience. And so then we're like we are looking for other signs from the universe telling us this is good or bad. And maybe that is things like romantic counters. Maybe it's like taking a leap in a business venture, like situations that you might only do a couple of times in your whole lifetime. And that's absolutely the moment where if you were an expert, like, this would be wonderful. You'd have all of that background.

15:07But if you're not the expert, the message is, let's pause and let's think about what the situation is telling me. Yeah, I guess I want to put then blindly trusting your gut in the same category as looking for answers in the stars. It seems very objective, but it's not valid. It's coming from a place of like, you do want to pay attention. Like, you want to pay attention to what's happening, what's triggering that feeling. And sometimes the cue to that feeling is not fully external. Like, it's important to even understand, am I being internally triggered too from something that is playing out in my mind that's causing these thoughts for which there's nothing about the environment or the risks or the stakes that are actually the issue.

15:47The issue is my own biases that I'm bringing to the table. So it is, there is something that's pulling this reaction to your gut, but I agree. It's like not quite as bad as astrology maybe, but it's like, it's getting there. Support for today's episode comes from Square. If you've ever been to a local business, a farmer's market vendor, a boutique, even a food truck, where everything just feels seamless, from ordering to checkout, there's a good chance Square is behind it. Square brings payments, POS, inventory, staffing, and online sales together in one system. So owners aren't juggling a dozen tools just to get through the day.

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18:50Okay, lightning round time. Are you ready? I'm so ready. Okay, worst GI advice you see given regularly? It would have to be probiotics. And this comes as a surprise because I think most people assume, based on the marketing, that gastroenterologists everywhere love probiotics, but we do not recommend probiotics for most conditions. The truth is that the data is far murkier, far less profound than you would be led to believe. And I find it really concerning when people are spending hundreds and hundreds of dollars on these probiotics. They're probably not getting the benefit they think they're getting.

19:25And they're focusing their attention on that rather than on the interventions that we know are better studied. So probiotics are like my big thing. Wow. All right. Right. What's your best advice, GI-wise? Best advice would be to treat your gut like a brain. Like if you were going to go bike riding, there's no way that your mom would let you do that without a helmet, right? We protect our brain so aggressively, but we throw any old thing in our stomachs. We wouldn't want to cross the blood-brain barrier, you know, but it actually is hitting that brain. So you would want to eat a high-fiber diet.

19:58You would want to prioritize sleep. You would want to prioritize exercise, eating fewer ultra processed foods, eating more whole foods. Those things are great for your brain, but they're also the same things that help protect your gut. So it's not it doesn't have to be overcomplicated once you start to think about it that way. What's something you've changed your mind about recently? Well, I will say this is like the biggest frame shift in all of GI. I used to think of cancer as a disease of older people. And if like a young person came to me and they were like, I've started having new diarrhea.

20:29even if I've seen blood in my stool, I would have said, okay, let's, you know, like, is this irritable bowel syndrome? Are these hemorrhoids? I wouldn't be thinking about cancer in a 20, 30-year-old. Today, I'm thinking about it. You know, most likely it is not what is happening, but it is a huge change in how I think, and I think about how all of us have been practicing. And you get to organize the world's greatest GI dinner party to talk about the gut with anyone alive or dead. Who are you inviting? Oh, this is so good. Ivan Pavlov is making that cut. He's getting on the list. Michael Levitt, Dr.

21:08Michael Levitt, was the father of flatulence research. If you don't know anything about him, you got to Google him and not just Google him, PubMed him. If you read the methods of his studies, you'll have so much respect for the scientific process. And like, you can understand why anyone who loved fart jokes as a kid should become a gastroenterology researcher. So he would totally make the list. And then I'd probably include my dad. He's like just the funniest guy I know. He's a neuro gastroenterologist. He's a researcher and he's just a very keen way of like pulling the threads together. So those three.

21:44Sounds like fun. All right. Office hours time. Do you have a puzzle problem or question for me. Yes, thank you. I have two. Okay. This first one is really relevant to my world in studying disorders of gut-brain interaction. And so one of the main things I study is something like irritable bowel syndrome or diseases that don't even really have a name. They're just characterized by pain, by chronic pain and situations where the testing is normal. And most often, these diseases happen more often in women. And women's pain, this is true in my field, it's true in all medicine, it's just, it's statistically undertreated, it's disbelieved more often than men's.

22:29And so, from a psychology standpoint, what I would love you to tell me is how to give women more of a concrete toolkit to advocate for themselves and being taken seriously by their doctor. I think a lot of people in the medical community are quick to tell women to just not believe them and tell them this is all in their heads. Like, how do we convince someone that someone's suffering is real? Wow. Well, I have two reactions. The first one is this should not be on women. This should be on medical professionals. Right. Yes. Period. Right. So let's change medical education to do a better job recognizing this bias and then counteracting it.

23:07I don't think that helps the average female patient overnight. So I think in the meantime, you're talking about a fundamental gap in empathy, right? A failure to be able to imagine somebody else's experience. And one of the ways that we close those gaps in psychology is we try to give people a more concrete look or direct sense of what the other person is experiencing. And so I think comparisons could be really helpful there. Um, you know, this hurts more than when I broke my foot or when I delivered a baby. Yeah. Like if you can put this on a relative scale and calibrate it against something that the provider can relate to, maybe it's a little harder to dismiss if you make it concrete that way.

23:51So maybe, maybe we need better pain scales that say, okay, zero is, you know, this is somebody poking you in the arm. Um, a 10 is, this is somebody amputating your arm. Yeah. You know, and then let's anchor each number on an imaginable form of pain that people have really lived. If you then give a 7 and the 7 is anchored to, I don't know, stepping on a Lego. Oh, that is really bad. That really hurts. If somebody says to a physician, this hurts more than if I just stepped on a Lego, I think it's hard not to pay attention. I love this because pain scales is like so embedded in our culture. Like if a patient comes in with pain, we're like, okay, where is it on a zero to 10?

24:35And they'll give a number. And the problem is that, yeah, we have our own subjective bias of what a 10 is. It's different from this person's 10. But if you were to say it's a seven and my seven is this, and then you give this concrete clip, I've actually never heard it portrayed that way. And like, I think that would be helpful. You know, when I talk to my residents and they're like, oh, this person said they're 10 out of 10, but like they were sitting on their bed relaxed. Like, I'm not worried. And I say, you know, if someone's saying it's 10 out of 10, then we have to take that at face value and we have to act on it.

25:03But I think it's adding a little more nuance to that that someone else can say, this is really what that feels like. This is relevant to something we talked about when we talked about taste last year, which is when I tell people that I don't like chocolate, they don't get it. When I tell them I would rather eat dirt than eat chocolate. Oh, OK, you must really hate it. And I think we need to do the same thing for pain. OK, what's your other question? Okay, my other question, something I've seen, we've all seen since the pandemic and even before that, is that health misinformation, it really sticks with people and it spreads in a way that selling facts just don't seem to do.

25:41And so doctors often struggle when they're just seeing one-on-one a patient who believes something is false. What are the tools that you think actually help change somebody's mind about health information? if you have like five minutes to do that. Yeah, it's - That's a big question, right? Yeah, it's not easy. David McRaney wrote a great book that covers a lot of the relevant research. It's called How Minds Change. I also love Switch by the Heath Brothers. And those would be my two go-to resources on this topic. I think in terms of specific recommendations, one thing is, I think, not immediately trying to make the other person feel like an idiot is always helpful.

26:21Yeah, that feels like a good foundation. Yes, love it. And saying, hey, you know, I really appreciate the fact that you came in here with a lot of information and you're clearly doing a lot of research. Yeah. And then, you know, trying to make it a dialogue and say, hey, my job is to help you separate signal from noise and really vet the rigor of these studies. So, you know, if you're open to it, can I walk you through what kind of study I would find credible versus not? And I think you're not going to change their mind in five minutes, right, by debunking the particular conspiracy or piece of misinformation they're buying into.

26:57What you want to do is establish a relationship whereby they trust your thought process, not just your conclusions. And they want to come to you to learn how to get better at critical thinking in your domain. I really like that. You have time, I think, to get them to believe that your way of thinking has some validity to it, even if you can't debunk that precise question. I like that a lot. Well, let me know how it goes for you. All right. I'm going to try it. So in our last few minutes here, I want to ask you a few more lightning questions if you're up for it because they're just so fun. Yeah.

27:28One is, I did not know until I read your book that it's possible to fight the smell of a fart. How? Yeah, a lot of people think it's an inevitability. But actually, 99 % of the gas that you release is odorless. It's only that 1 % that contains sulfur. That's the problem. Not surprising. It's the simplest solution. Bismuth subsalicylate found in products like Pepto-Bismol. It can neutralize the odors. So I don't think that we need to be like taking this every day the rest of our lives because I actually like don't think we need to live with that level of embarrassment. Once you know that people on average fart 10 to 20 times per day, you might realize you're not so different from everyone else.

28:12But I think if you have like a high risk social event, like you're visiting your in-laws for Thanksgiving or you're like, you know, in this like intimate work and you just you need that for your confidence. Like, go ahead and take it like a day or two beforehand. And you actually will be able to neutralize it. You have to work a little bit harder about the sounds, but you can definitely get rid of the odor. Speaking of reassuring information, what percent of adults poop their pants? Gosh, 7%. Like, that's a big number. If you think about the activity we're talking about, we don't talk about it.

28:43What it does tell me is that you're not alone, if that's you. 7 % poop their pants, like, regularly. The kind of, again, encouraging part of that is that for a lot of the reasons why this happens, we have really good treatments. This, we call it fecal incontinence, is one of the things that, of everything we've talked about today, that people listening are like, well, this is so embarrassing. It is so embarrassing that we know, because we've done these studies in GI, if the doctor doesn't ask the patient very specifically, do you have this? Do you poop your pants? Patients do not bring it up on their own.

29:18Like that is very rare. Even though they'll come to that visit, that is the most distressing. It is this thing that makes them say, I can't leave my house. So if anyone hears this, it's common. Talk to your doctor if your doctor has forgotten to ask you about it because the good news is that we can actually treat it. It's not inevitable. Great. Okay, one other myth to bust here. A lot of people have, I think, become fans of doing a colon cleanse or a detox ritual because they think there's poop or toxins lurking in their gut. Yeah. Not true? Not true. There is this cult of detoxification around.

29:55It's like detox culture is everywhere. And I actually, I kind of get where it comes from, like both in our current moment, which is like, you know, we think there are chemicals in the environment and our foods and pesticides and toxins. And I think it can feel really overwhelming, like we're putting poison in our bodies. And that's not the case. Like the awesome news is that everything that comes through your gut, it gets filtered first by your liver before it hits the rest of your circulation. Your liver is the cleanse that you need. Like there is no celery juice you could sip that is going to do a better job than your liver.

30:29And so like just I wouldn't worry so much about detoxing with like a quick fix. What I would worry about is like, what is my long-term dietary habits? What are the patterns that will over time stress my liver? And that is things like alcohol and ultra processed foods and things that your doctor has been beating you on the head over for like the last 50 years of your life that you kind of already knew. That's actually really encouraging. Yeah, cancel that colon cleanse. Yeah, I wasn't planning to do one, but I'm glad to know that that was not a bad call. This episode is sponsored by Kohler Smart Toilets.

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33:34I have to tell you, I was not sure what I was going to make of this book that you wrote. Because I think people are disgusted and grossed out by poop, period. Yeah. But then I was reminded of this research that Paul Rosen did on disgust. So Paul's basic argument was that, you know, disgust evolved to keep us safe. And we're disgusted by things that are toxic. And yet, some things that disgust us also intrigue us. He said, and I'm going to paraphrase here, but it stopped me in my tracks when he said, okay, so most people are grossed out by poop in all forms. Yeah. And yet most people are also curious about poop to the point that after they take a dump, they will look in the toilet and observe the shape and the color.

34:28And so this is kind of my long preamble to say, I think I've come around to the idea that this thing you study that people are disgusted by, they're also sort of intrigued by as adults, not just kids. Why? Why? What's going on here? Yeah. And you're asking someone who does this for a living. So we're in their like right space. But now I'm intrigued, too. I mean, were you surprised because you are one of those people who takes a look or because you're one of those people who absolutely says like, no, I don't look. I just flush and I move on with my day. I'd never even thought about it. And I didn't want to think about it.

35:02And it was so weird to me that somebody thought about it. Well, there's like a serious answer. And then there's like maybe the more real answer for like why people study this. And like I would say the serious answer is that your gut and your gut health is so important to your overall health. And when we take a bigger step back and we look at what's happening in the world today where a big conversation is about these early onset cases of colorectal cancer that we're missing. And we're missing them because people aren't bringing to their doctor's attention the symptoms about their guts because they're so embarrassed by it.

35:41People aren't even looking. They're not even looking before they flush. And like, honestly, when I hear that, and I hear that from a lot of my patients are like, oh, I don't look because my first question is, well, what does your poop look like? You know, then I find that bizarre because I think like, how can you not look? And so then that takes me to the like lighter side of this whole equation, which is, you know, in my world of neuro GI, it's kind of a relatively new subspecialty, but it's also the coolest subspecialty. The science is so exciting and emerging that I just think the way we've thought about our poop and about our bowels in a lot of ways has been proven so wrong over the last decades.

36:19And that's because I think for centuries, if not longer, we thought of our digestive tract as just this plumbing system, right? And it's like you eat, you poop it out, and that's kind of the end of the story. And then the microbiome entered the chat like 20, 30 years ago. And the whole world changed. And then we realized, and we kind of had hints that this was true earlier, that your gut is not just a set of pipes. It's a brain. It has this thing called an enteric nervous system. And if you shift that way of thinking, as I have, instead of thinking about your gut as this holding cell for your poop, and you think about it as a brain in and of itself, then one, you're not disgusted by it.

36:59You're fascinated by it. But then you also come to learn about all the different ways that not just your brain influences your gut, but also how your gut is influencing your brain. And the science of it is so exciting. Okay. So I have to ask you a bunch of things now. The first one is I remember in grad school, we were in a seminar talking about the difference between happiness and joy. Happiness being more of a typically cognitive evaluation of how satisfied are you with your life, and joy being the momentary exuberance that you get when you have a peak experience. And you know where this is going.

37:37Some psychologists had done— I am so excited. It was an experience sampling study where you get at joy by instead of just asking people how happy are you and then trying to figure out what did you do that day, Basically what they did was they texted or pinged you at different times throughout the day. And they said, right now, how much joy do you feel? And what do you do? Yeah. And the conclusion from my colleague was we're really just animals. Because the two highest moments of joy consistently in the data were having sex and sitting on the toilet. Yep. That tracks. And I remember our professor saying, joy equals sex plus shit.

38:18it's like an amazing class i mean it was it was a weird class in a lot of ways but i think that that foreshadowed something that you write about in your book which is the idea that people feel some degree of extreme joy when they are having a bowel movement explain this to me yeah that is a concept that i call puphoria and for example right now i i see a lot of patients with Parkinson's because that's what I study in my laboratory, the GI symptoms of Parkinson's. And as everyone knows, when you have something like Parkinson's disease, you have a lot of other very severe symptoms, things like tremors, difficulty walking, difficulty speaking.

38:57And yet when you talk to these patients, people will tell me if they could trade away one thing, whether it's the tremors or the constipation or difficulty sleeping, it would be the constipation. Like they would rather live with tremors than they would live with the severity of their GI symptoms. And I find that to be true almost across the spectrum. That no matter how successful you are in life, no matter what else is going on, whatever disease you have, if you cannot eat the food that you love and you cannot poop it out properly, people just don't feel joy. They don't feel like they have achieved like a high quality of life.

39:31And what I talk about when I'm talking about pooforia is like two stages, right? And one is long-term satisfaction with your bowel habits. And for me, maybe that's actually where having a bowel movement is the absolute least of your daily concerns. And 40 % of Americans, this is something that disrupts their daily lives. It's a huge number for something that we actually may or may not have a diagnosis attached to. We may not be talking about enough. But that's a lot of people who are not happy because they're not pooping well. But then there's also this like interesting phenomena, which again, we don't talk about that much probably out loud on a podcast or with friends, which is that like people feel such immense joy when they have a good bowel movement.

40:13And I actually do think that there's two reasons why this happens. One, it can be hard work for a lot of people. It's not effortless. It's not easy. And so sometimes people having a nice, good bowel movement really feels like a relief because they know now the rest of my day is not, I'm not going to be thinking about this and worried about where the bathroom is and feeling that heaviness. It's like a big sense of relief. And also there is this surge through your vagus nerve in order to have a bowel movement. That's very relaxing. That's like you have to have that in order to have a good bowel movement.

40:44So there's both this physiological basis and this sense of like achievement and relief that comes with having one. Is that related to dopamine? Because you've also shattered one of my assumptions about where dopamine lives. Yeah. So most of your body's dopamine comes from the gut. And I mentioned that my laboratory studies Parkinson's disease. But what we really study is dopamine signaling in the gut. And this is true. You'll hear this of a lot of other neurotransmitters that we think of as predominantly being brain-centric neurotransmitters like serotonin. That, too, is mostly produced by the gut.

41:17With the dopamine, though, the dopamine produced by your gut actually doesn't cross the blood-brain barrier. So it's not necessarily as though the dopamine produced by your gut is the thing that's immediately giving you that hit of, like, satisfaction. I think you get that. But I think that's predominantly coming from the experience in your mind playing out about that like genuine sense of relief. Got it. Okay, so what's your advice on how to get to pooforia? Yeah, well, sometimes I start with just the basics of what modern life has taken from us. And sometimes that conversation starts with me just saying, how are you sitting when you have a bowel movement, right?

41:55And everyone's like, that's a weird question. I just sit on the toilet as one would. and actually that's not the best or most natural way to have a bowel movement and when you sit in this like 90 degree angle like you're sitting on a chair there's a kink in your colon that tube is not all the way open when you squat as many people used to do in the past far fewer are doing that today for all the reasons i understand that actually the tube straightens up and you're able to pass stool a lot more easily and of course the next point is like nobody wants to squat i get that. But what you can do to achieve that, to open up that angle again, is just to raise your knees above the level of the waist.

42:32You can use a stool. You could use a stack of books. You could use a pair of stilettos. As long as you raise your knees above your waist, even healthy people will say, oh my gosh, I had no idea. This is way easier than it was. Another thing I talk about often is bringing our smartphones into the bathroom. That is like a big problem with our modern life, speaking of dopamine. But when you bring your smartphone into your bathroom, you're getting distracted by design. And, you know, we did this study in my laboratory where we found that people who bring their smartphone in the bathroom, which is everybody, okay, there's no shame in that.

43:05But those people, about half of them said they spent longer in the bathroom than they intended because they were distracted by their phone. That's not so surprising. There's no way we can expect you to focus on the job at hand in the bathroom if you have your smartphone and you're like in the middle of doom scrolling. And it's not so much like, oh, this is just going to waste your time, we're worried that this is what's driving hemorrhoids in a lot of people. Because the longer you sit on this open commode without any pelvic floor support, the more those hemorrhoidal veins they fill over time, that connective tissue weakens.

43:39So this is a habit that it's probably simpler to say we should break than it actually is, because we're all so addicted to our phones. But it's like one of those things, just like we don't bring our smartphone to the dinner table, to the bedroom, we probably shouldn't be bringing it to the bathroom either. Ooh, good advice. Well, Tricia, this has been every bit as fun and enlightening as I hoped, and also less gross. Yeah, I hope you feel that way, and I hope you take a look next time. I can't say I plan to, but thank you for joining us and at least inviting me to rethink that.

44:17Rethinking is hosted by me, Adam Grant. The show is produced by TED with Cosmic Standard. Our producer is Jessica Glazer. Our editor is Alejandra Salazar. Our engineer is Asia Pilar Simpson. Our technical director is Jacob Winnick. And our fact checker is Paul Durbin. Our team includes Eliza Smith, Roxanne Hailash, Banban Chang, Julia Dickerson, Tansika Sung Manivang, and Whitney Pennington Rogers. Original music by Hans Dale Su and Alison Leighton Brown.

44:47You know, I wash my hands after I poop like everybody else. You know, I'm a poop positive person, but like I have a reasonable distance to.

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