Dorie Shafrier (3:11)

Well, Elise, we are about to embark on another season of tennis.

Elise Hu (3:16)

Oh, it's the. It's a transitional time.

Dorie Shafrier (3:19)

It's a transitional time.

Elise Hu (3:20)

Okay.

Dr. Tricia Pasrisha (3:20)

Okay.

Dorie Shafrier (3:21)

Here in USTA league are. We have wrapped up the winter season.

Elise Hu (3:28)

Got it.

Dorie Shafrier (3:29)

And we are entering the spring season. The spring season kicks off this week.

Elise Hu (3:33)

Oh, are you still captaining or are you going to take a break?

Dorie Shafrier (3:37)

No, I sure am. I think I'm gonna. I think I'm gonna take a break this summer, actually.

Elise Hu (3:41)

Okay.

Dorie Shafrier (3:42)

Because in LA, the summer leagues are 40 and over. Mixed duckles.

Elise Hu (3:51)

Yeah.

Dorie Shafrier (3:51)

I don't love mixed doubles. The men bring a certain energy to the court that I'm just not well into life and. To life.

Dr. Tricia Pasrisha (3:59)

Yeah.

Dorie Shafrier (4:00)

It's like some of us joke. Like, we're like, why is there a man on the court? This is our little.

Elise Hu (4:05)

It's harshing my vibe.

Dorie Shafrier (4:07)

It is harshing my vibe. I mean, look, I don't want to paint them with too broad a brush, but they tend to bring a certain energy that I just am like, I don't. You know, I'm like, I do this for fun. I don't need the. I don't need these vibes.

Elise Hu (4:20)

Well, plus, you don't get to choose who you're playing against in the league or who is necessarily even on your

Dorie Shafrier (4:25)

team in the league. Yeah.

Elise Hu (4:26)

So, like, I would love to play tennis with a bunch of my guy friends, but that's not what you necessarily get.

Dorie Shafrier (4:32)

Right.

Dr. Tricia Pasrisha (4:33)

Exactly.

Elise Hu (4:33)

You're getting a lot of randos.

Dorie Shafrier (4:35)

You're getting a lot of randos. Yeah. And you don't know if the opposing team. The guy is going to, like, decide. He just wants to, like, bean it at the woman, which happens a lot. Like, it's just, like. It's just not. Just not cool. Anyway, so that's one of the summer leagues. And then the other summer league is called tri level, where you basically have, like, a small group of people at three different USTA ratings. And I've done tri level the past two summers. And, like, I don't know, it's Kind of a pain in the ass to put the teams together.

Elise Hu (5:05)

Okay.

Dorie Shafrier (5:06)

It's just like, a lot. And I was like, you know what? I don't think I want to do that this summer.

Elise Hu (5:10)

Well, it is just volunteer work too. Like, you don't have to do it, right?

Dorie Shafrier (5:13)

Volunteer work.

Elise Hu (5:14)

Correct.

Dorie Shafrier (5:15)

I don't have to do it. I'm not obligated to do it.

Elise Hu (5:19)

Right.

Dorie Shafrier (5:19)

So I'm gonna do the spring season. I'm captaining my teams. And then summer, I'm gonna just kind of chill. How about you? What's new with you?

Elise Hu (5:29)

I am on spring break, and I have only two kids. I always feel like when I only have two, when I'm down to two kids, I am killing it. I'm just like, dang, I am awesome. With only two kids. No offense to whichever third kid that I'm talking about. I just mean it's just like, man, we can do we a museum yesterday. And the family pass was for four. Exactly. And so that was the number that I had. I didn't have to do any extras. We can fit into cars easily with the dog. There's just some, like, advantages of having this particular even number. And the reason why I'm down a kid is a really cool reason. Just. Ava is in Peru. She was in Machu Picchu yesterday, saw a double rainbow. Today, is on some sort of river boat or something going through the Amazon rainforest. Like, she. She was in the Sacred Valley. They visited an elementary school there. They had the universality of, like, kids being kids with each other. They played, you know, soccer with these Peruvian elementary school kids. They. They were in Lima. They were in Cusco. She was at like 12,000 elevation. There were some kids who were really getting altitude sickness. She's just been all over the place. Planes, trains, and automobiles. Every morning they seem to have like a 6am departure for the next plane or the next train ride. And so I imagine she is just wiped out. But it seems like, oh, my God, they were holding baby alpacas.

Dorie Shafrier (7:11)

What is the. Is there like a. A reason or a theme for the trip? Like, why Peru? What are they doing?

Elise Hu (7:22)

So her favorite 6th grade teacher leads a tour group through one of these student travel companies. So it's not officially a school trip. It's sanctioned by the school, and a teacher at the school leads the trip. But anyone can go on it, really, and sign up to be part of this group.

Dorie Shafrier (7:42)

Interesting.

Elise Hu (7:43)

So it's all kids from the middle. Middle school, but also a lot of parents. So they're traveling as a group. Of 40? Yeah. As a group of 40, because I think it's 20 of the members of this group are full families.

Dorie Shafrier (7:59)

Wow.

Elise Hu (7:59)

And then nine of the kids are traveling solo, which is what Ava's doing is doing.

Dorie Shafrier (8:05)

Yeah.

Elise Hu (8:05)

And then there's teachers, other teachers from the school, and other adults who are chaperoning and who wanted to go, who might just be, like, one parent of one kid instead of, like, a full family. I think she's a world history teacher, so she likes to go to places with ancient civilizations.

Dorie Shafrier (8:19)

How cool.

Elise Hu (8:20)

And halfway through, though, Ava, I think she was just kind of crashing out because she's wiped out. And she was, like, texting me, going, I just want to be by a pool eating in and out like you guys are. Because that's what we're doing. We're doing this very retiree life. Scottsdale, Arizona, spring break, and we're going go karting and doing to the slide park and going to the museums and just spending breakfast, lunch, and dinner beside the pool. And I think that's what Ava's really coveting, even though she's a freaking Machu Picchu, seeing a double rainbow and just the magic and the energy of that, I really am envious of. But I was actually talking to my therapist about this this morning, and he's like, there's something about Peru that I hear is very magical. He's never been either. And he was just like, I bet it's one of those things. And I was like, I hope Ava's having a good time, because, you know, she. She's homesick. And she'll text every once in a while and be like, I don't know if I'm a Peru girly. I think I'm just, like a tan by the beach girly, which is very her.

Dr. Tricia Pasrisha (9:27)

I mean, look, I get it, but

Elise Hu (9:29)

there are many kinds of girlies. You can be like, we contain many girlies.

Dorie Shafrier (9:34)

And you know what, Elise? That is so true. We all contain many girlies.

Elise Hu (9:39)

That's right. That's right. And I was saying, like, I don't. I worry that Ava doesn't love, like, history and the journey, you know, as much as I did as I was a kid, because I remember keeping extensive travel logs when we traveled the American west and did all the national parks. And I'm just like, I don't know that Ava's really, like, getting into the indigenous populations there and la, la, la. And he was like, there are experiences that you have in your life that just kind of you. That seep into your pores. They seep into your, like, being. And it's just like it doesn't really matter if she remembers the facts of where she was or, you know, the play by play of what was on the agenda each day. It's actually just how the experience itself sort of is written on you later on and, like, it'll reverberate in different ways that are really valuable and that make it a really good investment. So that was a nice thing to remember. And I think that's true about a lot of the places that I've been or seen. Like, I don't really remember the details that well. I just remember the vibes. And I think that that's enough to change me in one way. Even if it's indescribable.

Dorie Shafrier (10:51)

Yeah. I mean, I think this is such an amazing experience that she's getting to have. And I get it. Like, you know, when you're in the middle of it and she's not getting a lot of sleep and she's away from her family, her family's just like, chill. I like, I get it. But she, I think she will look back on it and, you know, be like, wow, that was really cool.

Elise Hu (11:17)

I'm sure it's going to be really cool to look back on.

Dorie Shafrier (11:20)

Yeah, for sure.

Elise Hu (11:20)

And make for, make for some great stories.

Dorie Shafrier (11:23)

For sure. Elise, do you want to introduce our guest?

Elise Hu (11:28)

Yes, I'm excited to. Dr. Tricia Pasrisha is an instructor of medicine at Harvard Medical School and the Ask a Doctor columnist for the Washington Post, where she translates complex medical topics into much must read insights with a touch of humor for millions each week. A graduate of Harvard College, Dr. Pasricha earned her medical degree from Vanderbilt University School of Medicine and her Master of Public Health from the Harvard T.H. chan School of Public Health. Her training includes an internal medicine residency at the Johns Hopkins Hospital and gastroenterology and motility fellowships at MassGen. Currently, Dr. Pasrisha serves as director of the Institute for Gut Brain Research at Beth Israel Deaconess Medical center, leading an NIH funded research laboratory at the forefront of gut brain science. She does know a lot about gut health. Her work has been published in all the big Ones, the New England Journal of Medicine, JAMA Network, Open, and Nature Reviews. Crucially, she helped us with some, like, just really basic questions we had about bloat and constipation. And Dory says, this is probably the most educational interview that we've had in a long, long time.

Dorie Shafrier (12:37)

All right, before we get to Dr. Pasricha, just a reminder that you can Call or text us at 781-591-0390. You can email us at forever35podcastmail.com Our website is forever35podcast.com. We have links there to everything we mentioned on the show. We are also on Instagram @forever35 podcast and join our patreon@patreon.com Forever35 because not only do you get the semi monthly newsletter, not only do you get the casual chat, not only do you get our community chat on Patreon, our monthly pop culture recommendation episodes at the $10 level, the ad free episodes and a shout out on the podcast every month. But we are also doing live casual chats quarterly roughly. So the the next one is on Wednesday at 12:30 Pacific, 3:30 Eastern. We'll be live. You can be asking us questions, chatting with us and you just have to join the Patreon before that to get access. So, you know, I was thinking about it. It's kind of like you're like just paying for a live show. Five bucks.

Elise Hu (13:48)

That's less than a coffee these days at Starbucks or anywhere.

Dorie Shafrier (13:52)

By the way, even a drip coffee at Starbucks is like $4. And then if you want like any sort of latte, it's at least 650. I mean, it's crazy. Yeah, thank you for bringing that up. That is one of my pet peeves these days. All right, we're gonna take a short break and we will be talking to Dr. Pasricha when we get back. Stay tuned.

Elise Hu (14:15)

We'll be right back.

Dorie Shafrier (14:20)

You know, I feel like one of my sort of ongoing projects is working on creating a more peaceful nighttime routine for better sleep for sure. And I've been working on this for Henry as well. But I will say, you know, one of the biggest upgrades we made wasn't like aromatherapy or meditation, Right. It was actually their kid's mattress from Lisa. Since making the switch, he unwinds easier, he sleeps deeper, and I just feel like he wakes up for school in a good rested mood. The difference in his sleep is noticeable. His old mattress was like sagging and just not great. And the Lisa is so wonderful. But Lisa isn't just about sleep. It's about impact. They work with local nonprofits across the US to donate thousands of mattresses each year to families in need. With over 43,000 MAT donated to Date Plus, Lisa is committed to eco friendly materials and sustainable manufacturing practices and partners with organizations like Clean Hub and Green Worms to help remove harmful plastic waste from the environment. So go to Lisa.com for 20 off plus get an extra 50 off with promo code forever exclusive for our listeners. That's L E-E-S A.com promo code forever for 20% off plus an extra 50 off. Support our show and let them know we sent you after checkout Lisa.com, promo code forever.

Elise Hu (15:42)

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Dorie Shafrier (17:40)

Doctor Tricia Pasricha, welcome to Forever35. We're so excited to have you on the show.

Dr. Tricia Pasrisha (17:46)

Thank you so much for having me.

Dorie Shafrier (17:48)

We have a lot to discuss. One of the big topics of conversation I was saying about my previous co host Kate was butt care. So this is a very relevant topic for a lot of our listeners, I think. But before we get to poop and butts, we always ask our guests about a self care practice that they have. So is there something that you would consider self care?

Dr. Tricia Pasrisha (18:15)

Yeah, I mean for me, my self care is I think about what I am feeding my microbiome every day. So I practice self care by saying, did I feed something specifically for the microbes that are living inside me? And then, and then when I do it, you know, it helps my overall well being and in my health. So I think about that.

Elise Hu (18:35)

I have an immediate follow up question because what does it mean to properly feed our microbiome?

Dr. Tricia Pasrisha (18:44)

A fantastic follow up question. You know, it means feeding it something that's rich in prebiotics or probiotics. And I think it's very easy to go about your day eating a lot of ultra processed foods and refined carbs and things that will not make their way to those microbes. They'll just get absorbed very quickly. So I think about did I eat something that's high in fiber? Did I eat something like Greek yogurt? Maybe that's sometimes what I do. That's my probiotic. But something that's specifically nourishing the bacteria that by design is not going to be absorbed that you are not capable of digesting or absorbing. It will continue along your digestive tract to your colon and it'll feed them.

Elise Hu (19:26)

Okay, I really have to think about this in terms of I know the kids too. Like I feel like my kids eat all beige foods.

Dr. Tricia Pasrisha (19:36)

Yeah, I have a 2 year old and 4 year old so I get it. We love a good chicken nugget. But I also, I do make their breakfast and this is what they like. They eat a ton of nuts like all morning. They're snacking on, on nuts. Luckily we don't have nut allergies in the house. And they also love kiwis. Kiwis is like my secret weapon with kids. They like kiwis, helps them poop, helps us, it helps us all poop. But they, I give them two kiwis before bedtime and they do great.

Elise Hu (20:04)

That's a great hack.

Dorie Shafrier (20:05)

Could we, and I think this will help as we kind of transition into talking about your book and your, your work. But could we just sort of like back way up and talk about like what are we talking about when we talk about the microbiome, gut health, like all of these sort of buzzwords that I feel like we're hearing right now. And why do they matter?

Dr. Tricia Pasrisha (20:28)

The gut refers to this long tube that connects things from your mouth, your esophagus, your stomach, small bowel, large bowel, and then your exit hatch. That whole area is your gut. And the two things that I think we don't appreciate about that, I think everybody understands that kind of basic plumbing. We don't appreciate that your gut has its own brain and it has this network of neurons that is as complicated and as numerous as the number of neurons in your spinal cord. So I always think about my gut as a brain and gut health being closely tied to that connection between the brain in our stomachs and the brain in our heads. And then the microbiome, like you mentioned, the microbiome are these trillions of microbes that are living with us mostly in our colon. There's some also in our small bowel and other places. And they're not just these passive creatures that we have to feed, we do have to feed them. But what's so cool about the microbes is that depending on what we feed and how we treat them, they produce these compounds entirely on their own that we're not producing independently. Those compounds can then get absorbed into our bloodstream and have these anti inflammatory effects everywhere. So when I talk about gut health, I think I. The I think about it is the while the way you're treating your gut and the way you're making sure that you are respecting healing your gut actually has an impact on your whole body. It's really your whole body health when we talk about gut health. So there are a lot of different angles you can go in this. I find there are a lot of people who like to go down the route of like, here's a gut health hack and here's like the quick fix. And there's often not a quick fix in, in gi in my field. And most of what I tell people and talk about are about building habits and lifelong changes. Those are harder to implement, but they are the things that stick and have really important outcomes for our health.

Elise Hu (22:14)

So your new book is called you've been pooping all wrong. I didn't know we were pooping all wrong. So what are we getting wrong exactly?

Dr. Tricia Pasrisha (22:25)

Yeah, what are we getting right is a better question to start with. But one of the statistics that prompted me to write this, this book was, and I saw it in my clinic in everyday real life, which is that 40% of Americans will say that their bowel habits disrupt their daily lives. Oh my gosh. Huge, huge number of people. And it's, it's almost like disproportionate to the number of people you think. Like when you go about your day, you go to work, you see people in the grocery store, like 40% of us all living lurking around us are really struggling every day. We just don't talk about it as much as we should. And I came to realize that a lot of what we know about pooping, most of what most people know about pooping is what their parents taught them when they were potty training. Like, that was the last and most important conversation you had about how this is supposed to work. The science has changed within the last several decades. Centuries. But we're still kind of learning our great grandmother's method. It's not right, and it's not helping us. And I think that's how we ended up in this situation where we are today, where we are not talking about our problems, we're not teaching each other and our kids what the right sort of scientific way to do this is, and about our bodies. And that's why almost half of us struggle with this every single day.

Elise Hu (23:35)

So for the two out of five Americans who answered the survey this way, how are their bowel habits disrupted or disrupting the day?

Dr. Tricia Pasrisha (23:44)

Yeah, I mean, the ways that I hear this, when people come to my clinic will be like, for example, people cannot leave the house because they're embarrassed to say, yeah, I'll go out to brunch with my friends because they're like, well, what is the bathroom situation gonna look like? Or they'll be like, I could go for this walk with my dog, but what if we take a detour and I'm not going to make it back in time? Let me just stay at home. Let me not go. Or it could be in a situation where they spend so much time in the bathroom every morning that their partner gets annoyed at them for hogging the bathroom, and they get late to wherever they need to go. Or every time they eat, they feel pain and cramping and discomfort, and it keeps them from being able to focus. So there's a number of different ways, and everyone is a little bit different. But ultimately, for a lot of people, it can stem back to the same misunderstanding about how the bowels work, and then the lack of knowledge about how to apply the treatments and the fixes that can get you back on track. Not necessarily with medication. There are medications that treat a lot of different health disorders, but oftentimes I find that sometimes teaching people some of the absolute basics, even just about what is normal when it comes to bowel move, like, this is the most basic question, but, like, is my poop normal? Is a question I get all the time. People don't know what normal looks like, and once you Learn some of these elementary, what I consider very elementary things. Then you actually can figure out ways to kind of get yourself on track so that your life isn't hijacked by your bathroom.

Elise Hu (25:12)

So how would you define normal pooping or normal poop?

Dorie Shafrier (25:16)

This is the question.

Dr. Tricia Pasrisha (25:19)

That is the question. Well, you know, there are a lot of different metrics that people throw out there. People, you know, think that what I'm about to say is going to be, we have to poop once a day. That's what makes you normal. And we have held this, number one, like, in this, like, godlike position for so long. And in my mind, that's actually not the definition of normal. I have met many people who poop once a day, and they're not normal and they're struggling and they're straining for 15 minutes in the bathroom to get that one poop a day. That's constipated, in my opinion. To me, what would make somebody have what I'd consider normal bowel movements would be, one, it should be effortless. Effortless and comfortable. Effortless means you're not sitting there straining for more than five minutes. It doesn't hurt, you don't have severe cramps. And then two, it should happen in a way that doesn't disrupt your social life. This shouldn't be the thing that makes you get up and leave your group of friends when you're all sitting out at lunch. It shouldn't be the thing that annoys your partner all the time, and you can't get anywhere where you need to be. So it shouldn't disrupt your social life. You should just live. A life that's normal to me would be one in which pooping, how many times you're going, what it looks like, what it feels like, is actually the least important thing of your whole day.

Dorie Shafrier (26:33)

And so what do you do if your poop is not normal?

Dr. Tricia Pasrisha (26:37)

Well, the first step is to even understand what's normal for you. I mean, you'd be surprised at how many people I see who, like, for example, if I ask them, well, what did your poop look like this past week? Like, give me a sense. And they'll be like, oh, I know, I didn't really look every day. And I'll be like, first of all, how do you not look? I don't understand. But then, two, you have to know what your normal habit looks like. And you have to know what these small changes in your own pattern look like for you to identify when something is abnormal. If you don't know what's normal for you. And that does mean taking a look and understanding how changes in your diet and stress and travel, all of these things are going to change what your poop looks like and what it does. Does. If you understand that and then you see a change, you have to talk to your doctor. And there are some scenarios where I would say, you know, like, it might not be such a big deal if you see a change in your poop. Maybe we have a good explanation. But to be honest, in today's day and age, it's like 20, 26, colorectal cancer cases are rising in younger people. And one of the big signs is as vague as a change in your bowel habits. That's like a. A really nebulous thing to say kind of deliberately because sometimes the only sign is new diarrhea, like just slightly looser stools than you're used to. Or maybe suddenly the stool goes into like this pencil thin form and it wasn't like that before. So subtle changes in your pattern can actually be incredibly important. The most likely scenario is that it's no big deal. We'll figure out what that etiology is, but we also want to make sure we're not missing anything scarier. Right, Right.

Dorie Shafrier (28:17)

So what, what I'm hearing from you is that we all need to be a little bit more in tune with our bodies and what comes out of our bodies. Because if we don't have this sort of baseline, then how do we know if something is not normal for us?

Dr. Tricia Pasrisha (28:34)

Yeah, I mean, there's this really disturbing statistic. This was from a UK study, but about one in three people are so embarrassed by their bowel habits that they will avoid talking to their doctor. And that's the last thing. Like, we want you to talk to your doctor early and often. I don't think it has to be. I think, you know, especially with younger people, oftentimes you think that it has to reach a crisis for you to talk and get help. It doesn't have to be a crisis, it just has to be a change. Just get that quick reassurance. Oftentimes it will be no big deal. But if you delay, I mean, you know, and again, I'm using the extreme case of cancer. But with colorectal cancer, that's one of the reasons that we catch it late at a later stage in younger people is because there's this big delay in capt.

Elise Hu (29:22)

Speaking of this big rise in colon cancer or colorectal cancer, especially among younger people, like in their 30s. What is the explanation for that from what the research can understand right now and then what do we do about it?

Dr. Tricia Pasrisha (29:35)

Yeah, it's been rising since about the 1980s and 1990s in younger people. And researchers think that one, we know that, that the big risk factor for cancer, which we used to think of decades ago, smoking, that's certainly gone down.

Elise Hu (29:50)

Right.

Dr. Tricia Pasrisha (29:51)

Our genetics haven't really changed across generations. So researchers have really concluded that it's in our environment. And more and more data is pointing towards food. And in the last two or three years, more and more studies have come out about ultra processed foods playing a big role. So it's probably not just one thing. I think there are a lot of different things in our environment, but I do think the umbrella of ultra processed foods covers a lot of them. So for example, it's not just the diet that we eat in our 20twent twenties and thirties when we're diagnosed. A lot of the data is pointing towards how we have been eating in our childhood, in our adolescence that's contributing to these early onset cases. And I know that's, I mean it's something I think about a lot with my kids, but they've done these studies with sugar sweetened beverages which when I was a kid I was drinking a lot of those, like Capri Suns and like all of like I was drinking all of this stuff as a kid. Hawaiian punch, high C hi C I remember hi C had it in my lunchbox. But those types of drinks are linked to early onset colorectal cancer and drinking those in your adolescence. Ultra processed foods are a big one. And today the average American is getting about 60% of their foods from ultra processed foods. And the problem with that is one, what's inside of them. These emulsifiers and chemicals have been shown to be linked to inflammation, microscopic inflammation in the gut which we think contributes. But also when you're getting most of your food from ultra processed foods, it means you're not getting fiber because most ultra processed foods are just very low in fiber. Fiber is protective against many cancers, but especially colorectal cancer. I can't go back in time and like pull the Capri sun out of my hands, but I can today say I'm going to try to make these small changes in my diet to eat more whole foods. I'm going to cut down on the sugar sweetened beverages. I'm going to be more active. These kinds of things we do have some control over and certainly we can never tell somebody that we can make your risk of cancer zero. Even if you do all the quote right things. Right? Like we know these cases of people who we think have done the right things, they still get cancer. And that's probably because of these uncontrollable risk factors that happened a long time ago or are related to genes. But we do know that we can lower that risk significantly if we take a few steps.

Elise Hu (32:01)

Okay, let's take a break and we will be right back. One of the fastest ways to irritate me is to see or feel my sheets slipping off the corner of my mattress. This is so annoying.

Dorie Shafrier (32:16)

That's the worst.

Elise Hu (32:17)

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Dorie Shafrier (35:22)

I'm wondering how you got interested in gastroenterology. What made you want to, you know, think about people's poop all the time?

Dr. Tricia Pasrisha (35:31)

I think there was never a time in my life when I didn't want to do gastroenterology. That's a weird thing to say. I recognize it's a weird thing to say, but my father was a gastroenterologist and so I'm a second generation gastroenterologist and I just grew up in this very poop friendly, poop positive household. And it went, for me, it went well beyond just like what you might imagine having a dad as gastroenterologist, which was like, yeah, he did check in. He was like, hey, did you guys poop this morning, like me and my siblings? And he would check in and make sure that was happening in kind of like a normal way. But he was so. He was also a researcher and still is, but he was so passionate and excited about his field and about how the gut worked. And in the 1990s when I was growing up, that was really when people were starting to understand that your gut is its own brain. And they were understanding how powerfully, not just the brain in our heads influences our gut, but how the gut influences the brain. And so it was an exploding field. He was so excited about it, and that was really an infectious kind of energy to be growing up around. And so I never thought of almost doing anything else other than becoming a gastroenterologist. I know, that's like really bizarre.

Dorie Shafrier (36:44)

I love that. I love that. Gastroenterology is like the family business.

Dr. Tricia Pasrisha (36:49)

Yeah, yeah. We, we like to say that your end is our means.

Elise Hu (36:54)

I love that.

Dr. Tricia Pasrisha (36:55)

That's.

Dorie Shafrier (36:56)

That's great. You also write the Ask a Doctor column for The Washington Post. Post. And I'm wondering what are some of the common questions that you get? I write a workplace advice column for Slate, and I will say that I see the same kind of buckets of questions all the time. So I'm wondering what that is like in the medical world.

Dr. Tricia Pasrisha (37:19)

Yeah, Yeah. I love writing this column because I do love hearing from readers and having my pulse on what the conversations are. And I get a couple different categories of questions. One, I actually think the most unfortunate category that I get get is like, someone writing in with a highly specific, detailed medical question. I get a lot of those. And it's like, one, it tells me that we have such a broken medical system because they're not able to get attention from their doctors and whatever. So that's hard. And I usually can't answer those. But then I get a lot of great questions. I mean, most of the columns stem from a question that we've read about supplements and about trends on social media. And what I find interesting is that for the most part, I think a lot of supplements, you know, like, there are a couple out there that have some good data. Most of the time there's. Whatever supplement du jour is out there is not necessarily been backed by data. But every now and then there is a cool trend happening on social media that I'm like a hundred percent there for, and I wouldn't have heard of it. And I. And I get excited and I get like, forgetful fiber maxing. I'm totally here for fiber maxing. And I didn't know that was a thing until people started like, writing in, like, is this safe? Is this good? And I was like, wow, I see zero downsides here from this, like, trend, other than, like, you could get bloated if you overdo it for sure.

Dorie Shafrier (38:39)

But.

Dr. Tricia Pasrisha (38:40)

But it's great. So I, like, love learning about kind of social media trends. And then I. I also get this, like, interesting category of questions that people write in about, like, what I would cons, what I think some people would consider, like, a very embarrassing question. But they're writing, like, for a friend. They're like, I have a friend who has, like, this very, very specific embarrassing problem. And. And I'm like, you know, it's already an anonymous column. You don't have to worry about.

Elise Hu (39:03)

You don't have to.

Dr. Tricia Pasrisha (39:04)

Right, yeah.

Elise Hu (39:04)

You don't have to project it onto someone else.

Dr. Tricia Pasrisha (39:06)

Right? Yeah. Just say, just say it, because I'm not going to say your name. Okay. I will never publish names or anything, but it's like, it's very interesting to see. And it's always like the friend when it's like, you know, often like an embarrassing GI issue. But, you know, and one thing I have learned over the years is that GI questions are very popular. So it's like, very convenient that I'm a gastroenterologist. And it's like, funny how for a topic that is so some people consider taboo or embarrassing or shameful, people are looking and desperate for that information. Like one, when I write about a GI topic, it does so well, like on our site, on social media. And I think it's because people are all curious. We're all clearly 40% of us are dealing with these problems. But it's in a way comforting to get some good information from a source that doesn't involve you, like going into a doctor's office and like, making eye contact with another soul and telling them something really embarrassing about a part of your body that you don't want of discussing out loud. Now, everyone should talk to their own doctor, but I can see the appeal of wanting to get good information, at least to like, have some talking points in a way that's like, you know, you can just like be by yourself under the covers, like scrolling and learning about your own body.

Elise Hu (40:18)

You brought up earlier the connection between fiber and bloating. And I know that you debunk a lot of misconceptions about bloating in your work. So what do we misunderstand or what needs myth busting when it comes to bloating?

Dr. Tricia Pasrisha (40:34)

Yeah, Bloating is one of the most vexing problems in gi, and it's one of those complaints that we, I think all of us experience. Women certainly do more than men, but it's really common for people to come to their doctors with bloating. And sometimes there is a really simple solution. Sometimes it's a little bit more nuanced. And I'll start by saying that before I tell you what I think the simple solutions are, there's one scenario in bloating that I like to make sure nobody misses, which is that if you are a woman who is postmenopausal and you get new bloating for the first time, that's a big red flag. And, you know, just so you know, that's actually a really concerning sign to me. As women, we, like, live with bloating all the time, and so we think it's normal. But I wouldn't brush this off if you have new bloating that you, like, wake up with, because it could be A sign of ovarian cancer, which is not to scare people. But ovarian cancer is this kind of silent disease until it's not. And one of the biggest missed signs is new bloating. So I start the conversation that way. But for everybody else, bloating can be quite normal. It's normal to have a little bit of bloating after meals. And some of that is what you've eaten, some of that is how your body is processing what you've eaten. And the two most common reasons people get bloated is, is the kinds of foods, the kinds of foods that are difficult to digest, and constipation. And sometimes people don't realize that they're constipated until we really push and try to figure out what's going on. But the big offenders in terms of foods are cruciferous vegetables. Big one like broccoli, cauliflower, Brussels sprouts. Artificial sweeteners gets people like, they'll have these like zero sugar kind of beverages or foods. And actually what's in there are these artificial sweeteners that are notorious for causing bloating. Gum chewing is a big one. If you have a CPAP mask that's not fitting correctly, that'll give you a lot of bloating. And then sometimes if you've like, tried, you're like, I've, I don't feel like it's really anything I'm eating. It's just kind of there. I ask a lot about, well, how what are your bowel habits like? And it turns out that a lot of people, like I said, who might say, well, I go every day. If you're straining a lot, if you don't feel like you get everything out, even though, yeah, you go every day, you actually could be very constipated. And we need to figure that out. There is a little bit of a quick fix. And I usually, I'm very hesitant to say the word quick fix. Okay. In like most scenarios, I don't do that. But this one is actually like really good. If you feel bloated after a heavy meal, the quick fix is to go for a walk. Specifically a fart walk. This has been like oddly studied. Yeah, it's like a fart walk. Who doesn't love a good old fashioned fart walk? But they've actually done these studies where they've simulated a meal. This was like, get the gastroenterology, like researchers of yore, they simulated a meal and they saw what happened when you either did like a little bit of a slow walk or a little low cycling. And it's true that that meal just passes so much more quickly and efficiently when you just do a little bit of exercise within like 10 to 15 meals of finishing it up. It also lowers your blood sugar after a meal, which is wonderful for metabolic health. So it's a. I love a fart walk. If you can't do the fart walk for whatever reason, like, you're stuck at home. At very least I tell people if you're feeling bloated, you should try to not give in to that instinct to lie down on your couch. Because intestinal gas actually moves about 33% more efficiently when you're sitting upright, as opposed to going fully horizontal. So as much as you can with your posture, stay straight. That actually will help with bloating.

Dorie Shafrier (44:08)

I never really thought about, like, what. What does it actually mean, like, for digestion?

Dr. Tricia Pasrisha (44:13)

Totally.

Dorie Shafrier (44:14)

But yeah, like, it makes sense. Sense.

Dr. Tricia Pasrisha (44:16)

Even if. Yeah, I mean, even if you're not farting, which is, you know, to lovely. If it happens, it's fine. If it doesn't, Your intestines do start to get triggered to move and contract just with your exercise. I mean, this is also why I think people who get hospitalized undergo surgeries and they're lying around in the hospital for days. Like, it's really hard for them to have bowel movements. Like, I remember after I had my kids and I was like, kind of in the hospital for a couple of days recovering, it's really hard for, for new moms in those first few days. Part of it is just getting up and walking. That's kind of how your gut realizes that it's time to move.

Elise Hu (44:50)

Okay. However, one thing that really affects my regularity is travel. So, like when I'm doing a bunch of time zone changes when I'm flying around a lot. What is your advice for keeping it regular? Keeping our poops normal when we're on the road?

Dorie Shafrier (45:09)

Code?

Dr. Tricia Pasrisha (45:09)

Yeah, that's a big one. That affects a lot of people. About one to two out of three people struggle to have a bowel movement on vacation. So you're not alone. That's a lot of people. And you know, I think what people don't appreciate about the colon, which is that last part of our GI tract, is that it actually has a circadian rhythm and it's very different from the other organs in our body. Like, if you can imagine, when you go to sleep, sleep, your colon actually also goes to sleep. It enters this like, peaceful quiescent state. Even though all the other organs in Your body, your heart's still beating, your lungs are still moving air, your colon is done for the night. And that means that when your circadian rhythm gets thrown off, your colon is also equally thrown off and doesn't know how to behave. So when I travel, I do a couple of things. One, I make sure I'm sending the right cues to my gut about the time zone that I'm going to be in. So, like, the moment I get on the plane, if I'm going to change time zones, start thinking as if I'm already there. And the two most important things you can do are one, shift your light cues. So, like, if it's nighttime where you're going, put that light blocking mask on. This is not just you'll have more energy when you arrive. This is really for your gut. And then two, eating is one of the most important triggers that tells your gut what time of day it is. Right? Because we don't eat at night. Eating stimulates contractions. So if it's nighttime where you're going, but you are eating a lot of food right now, it's telling your colon to stay awake. Stay awake. We're still, we're still at daytime. I don't take. Do that. I start eating according to the time zone that I'm traveling to so that my colon knows where to go. But then the other thing is very simple. I think a big reason people get constipated on vacation is they don't eat the kinds of foods they eat at home. They start to eat, like, more rich, highly refined. I mean, that's what I do when I go on vacation is I'm sure to indulge, right? Who isn't? But I now try to make a really big point to seek out fiber, like, more than I would have. I will eat like a side of broccoli. I will order like a real adult vegetable at dinner as opposed to like some weak Caesar salad, which is not actually giving me that much fiber. Like a little leaf of lettuce on my burger, it's not going to cut it. You have to eat a lot more fiber. And then I think that, like, other big problem is that oftentimes when you're traveling, you don't feel like you have this safe bathroom like the one you have at home. You're, like, with a partner or maybe with 20 cousins. People are running to, like, the hotel lobby, or you're like, out and about and you're looking for, like, a friendly coffee shop. It's horrible. That will also throw people off we have a little bit less control over that. But I think if you eat more fiber, you're drinking a lot of water, you're adjusting your time zone, you can get back on track.

Elise Hu (47:45)

Okay, fantastic.

Dorie Shafrier (47:48)

Elise, do you feel confident about heading into your next. Your next travel?

Elise Hu (47:54)

Well, I realized this about my regularity a long time ago, and so now I'm, like, really aggressive about eating vegetables when I'm on the road.

Grow Therapy Advertiser (48:04)

Good.

Elise Hu (48:05)

And so, in fact, I might not see a vegetable at home for, like, four or five days, but when I'm traveling, every meal is very green.

Grow Therapy Advertiser (48:14)

Yeah.

Dr. Tricia Pasrisha (48:15)

Yeah. And I would say even if, like, you can't find a vegetable to save your life because you're on this cruise and, like, who knows what's going on? Like, just pack your own fiber supplement. Like, that's the easiest thing you could do.

Elise Hu (48:25)

Oh, that's a good tip, because I'm sending my daughter off on an international trip on Saturday.

Dr. Tricia Pasrisha (48:30)

Yeah, send her with a little psyllium husk. Okay.

Elise Hu (48:35)

Adding it to the packing list.

Dorie Shafrier (48:39)

Okay, so before we let you go, my. I. I did ask my husband, because he has a lot of interest in this topic, if he had any questions for you.

Dr. Tricia Pasrisha (48:49)

And his many husbands do.

Dorie Shafrier (48:51)

Yes. His question was actually something that you already touched on that I was hoping you could elaborate on. And it is, I suspect, my CPAP made me Gassier. Is this possible? And I was like, yes.

Dr. Tricia Pasrisha (49:05)

Wow. He's very perceptive. And he's right. I think, actually, I'm so glad that he noticed that, because I do think, actually, CPAP machines fly under the radar as a cause of bloating and gas. Like, this is one of those things that, like, we will have tried lots of different things in the clinic to figure it out. And then suddenly there'll be this light bulb moment where I'll be like, wait a minute. Do you use a CPAP machine? And then they'll be like, yes, I do. And then we'll realize, you know what? It's the mask. And sometimes it can be as simple as you're actually just not wearing a, like, appropriately fitted mask. Maybe you need a nude. A different kind of mask. I would have it checked out by a specialist. Like, there are people who come in, assess the fit, and do that, see if that's the cause, and you never know. But that's like a. That one flies under the radar, and it's very common.

Elise Hu (49:49)

Okay.

Dorie Shafrier (49:49)

Wow.

Dr. Tricia Pasrisha (49:50)

Fantastic.

Elise Hu (49:51)

All right. Dr. Tricia. Patricia. How can people find you? You?

Dr. Tricia Pasrisha (49:56)

They can find me on Instagram. They can read my column in The Washington Post. Or they can check out you've been pooping all wrong, which is in bookstores everywhere.

Dorie Shafrier (50:04)

Thank you so much. This was very, I would say, one of our most educational conversations ever. So thank you.

Dr. Tricia Pasrisha (50:11)

Honored. Thank you.

Dorie Shafrier (50:15)

All right, well, I. I do feel much more educated on my colon and my butt. But after talking to Dr. Pastricha, I really feel like we probably should have had Kate Spencer on as a guest.

Elise Hu (50:27)

Oh, my gosh, it'd be perfect.

Dorie Shafrier (50:29)

Yeah, it would have been perfect. But anyway, I hope she listens to this episode. All right. The intention zone. Last week, I said I was going to declutter and continue selling stuff. And I gotta say, like, I look around my office now. I've been, like, gradually making my way, like, from the door to my office, sort of, like, back, back.

Elise Hu (50:51)

Huh, huh.

Dorie Shafrier (50:52)

And the. There is, like, a huge part of my office that is just open and clean. That's great. It hasn't. You know, as I was doing it, I was like, oh, my God, I still have so much more to go. And then this morning, I was like, oh, it's, like, so much better.

Elise Hu (51:09)

Yeah.

Dorie Shafrier (51:10)

Like, it really, like, hit me that at least, like, this half of the office is so much cleaner. There's just not stuff everywhere. And I was like, oh, my God, I'm doing it.

Elise Hu (51:21)

There really is something to the incremental change, you know, or, like, the daily habits are what leads to big change. It's never, like, one big change. It's little incremental steps.

Dorie Shafrier (51:29)

But, you know, I think for us, like, we needed the big change. We needed, like, the shock and awe of cleaning our house. But I was saying to Matt, like, we've kept it clean for over a month.

Elise Hu (51:40)

That's great.

Dorie Shafrier (51:41)

Like, the bad habits have not crept back in, which feels really, really, really good. This week, we're having people over again.

Elise Hu (51:48)

Oh, fun.

Dorie Shafrier (51:49)

We're. We're gonna do a seder. We're gonna have one of Henry's friends and his parents, and actually, I'm good friends with his. With the mom, so that'll be nice. Yay. Yeah. So we're having another. Another time, you know, people coming over again.

Dr. Tricia Pasrisha (52:03)

Yeah.

Dorie Shafrier (52:04)

Hosting again, which didn't happen for a very long time. So just kind of, like, getting prepped for that is, like, my intention for this week. But we don't have to do a full house cleaning.

Elise Hu (52:15)

You don't? Because it's already done.

Dorie Shafrier (52:17)

It's already done.

Elise Hu (52:17)

Already done.

Dorie Shafrier (52:18)

How about you, Elise?

Elise Hu (52:20)

Last week I said I wanted to try something new, and I didn't mean, like skydiving or anything. I just thought maybe I would, like, try a different cycling class or try a cycling class, which I haven't done in many years or something, and I

Dr. Tricia Pasrisha (52:32)

don't know what I did.

Elise Hu (52:33)

Oh, I did do one thing. I have leveled up in one way, actually. Dora and I just thought of it.

Dr. Tricia Pasrisha (52:37)

Okay.

Elise Hu (52:38)

I usually don't drive by myself longer than three hours or three and a half hours.

Dorie Shafrier (52:42)

Oh, interesting.

Elise Hu (52:43)

Because we wanted to. To have Oscar with us for spring break in Scottsdale. I drove the girls and the dog all by myself for six hours. So I did something I've never done before as an adult. So I did that for myself, which was good, actually. That was the one new thing that's like. That's one way that I leveled up. I needed a lot of encouragement because I just thought I'd be so bored, and I never want to be in the car that long. But the girls were awesome and entertaining, and we played the Alphabet game with the license plates and. And I listened to Chanel Miller's memoir, Know My Name, which is very good. She does it herself. And I haven't finished it, but that was really gripping. So that's my one thing that I did that was new. And then Oscar's done something new. He's gone swimming, and Ava's done something new. She went on an international trip to Latin America, to South America, without the rest of her family at age 13. We're so proud of her. And then. And the younger girls did all sorts of really tricky slides, like big drops that launch you high up into the air at the end. And so they did some. They really leveled up, too. So feeling very robust and rich. Like, my life is very rich. So this week, it's just to be present. My intention is just to be present. And because we're going to return to work after break, and then I'm sure I'm going to be harried because after every break period, things pile up, and then I get stressed out because I have to catch up on everything that I put aside. And so it'll be a real challenge just to, like, sit at all the meals and talk to everybody without, like, having my head in another place. So I'm just. That's. I'm just intending and putting it out there to just kind of be there and be present and give my attention to whatever's right in front of me.

Dorie Shafrier (54:31)

Great. I love that. All right, well, this is also the episode where we thank our Patreon supporters at the $10 level or above so I will read the names of these wonderful supporters. Thank you to Alvin, Ariel C, Laura Ciccone, Sarah Liska, Felicia Justice Biro, Jasmine De Jesus, Christy, Caitlyn H. Katie Ashley Taylor, Teresa Anderson, Nicole Gass, Maya Barbara C. Amy Amy Schnitzer, Megan Shelly Lee, Sarah Boozi, Allison Cohen, Melissa McClellan, Plane Jackie Leventhal, Fran Kelsey Wolf, Donnay Laura Eddy Jettle, Apti, Valerie Bruno, Julie Daniel E. Jackson, Alicia Catherine Burke, Amy Maseko, Liz Rain, Jdk, Hannah M, Julia P. Maddie o', Day, Marissa Sarah Bell, Maria Diana Saint, Cocoa Bean, Laura Haddon, Josie H. Nikki Bosser, Juliana Duff, Chelsea Torres, Tiffany G, Stephanie Germana, Olivia Fahey, Elizabeth A, Christine Bassis, Jessica Gale, Zulima Lundy, Carolyn Rodriguez, Carrie Golds and T. Katherine Ellingson, Kara Brugman, Sarah H, Sarah Egan, Jess Combin, Jennifer Olson, Jennifer hs, Eliza Gibson, Jillian Bowman, Brianne Macy, Elizabeth Holland, Karen Perelman, Katie Jordan, Sarah M, Kate M. Josie Alquist, Tara Todd, Elizabeth Cleary and Monica. Thank you all so much. We are so grateful both for you. Anyone still listening who is not a Patreon supporter, please Support us@patreon.com Forever35 and just a reminder that Forever35 is hosted and produced by me, Dory Shafrier and Elise Hu and produced and edited by Sam Hunio. Sammy Reed is our Project Manager and our network partner is a cast. Thanks so much everybody. Bye.

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