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Gloss Angeles
GLP-1s, “Fibermaxxing,” and Pooping: A Gastroenterologist Explains the Gut-Brain Connection
00:37:19
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- [00:00]
Liv Perez
Hi, I'm Liv Perez from the let's Get Dressed podcast and this episode is presented to you by depop. If you've been meaning to clean out your closet, but it feels so overwhelming, my best piece of advice for you as a fashion expert is to start with one thing. Depop. Depop makes it so simple to give your pieces a new home. Just snap a photo and their AI powered listings. Fill in all the details for you. And here's the best part. Make money easily. With no selling fees on Depop, no seller fees means that you earn exactly what is yours. Another perk. There is someone out there who's going to love that piece the way that you did and who doesn't love making room for something new too. Download the Depop app and list your first item today.
- [00:42]
Dr. Trisha Pashrika
Glam los angeles.
- [00:47]
Sarah
Hi, kirby.
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Liv Perez
Hi, sarah.
- [00:49]
Sarah
Welcome to los angeles. So my favorite people to follow on social media are experts. Of those experts, my favorites are doctors. And our guest, I should say, is one of my favorite doctors to follow on social media. I have learned so much. Dr. Trisha Pashrika is a physician scientist at Beth Israel Deaconess Medical center, an assistant professor of medicine at Harvard Medical School and the director of the Institute for Gut Brain Research. She's also the Ask a Doctor columnist for the Washington Post. She is a double fellowship trained gastroenterologist from Massachusetts General Hospital and currently leads an NIH funded laboratory investigating the complex communication between the brain and the gut. And her highly anticipated new book, you've been pooping all Wrong comes out April 7th.
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Kirby
Welcome to Los Angeles. Dr. Tricia. How are you?
- [01:44]
Dr. Trisha Pashrika
Great. I am so delighted to be here. Thanks for having me.
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Kirby
Of course. It's fun seeing you IRL compared to just when we're scrolling on our phones.
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Dr. Trisha Pashrika
Likewise. Like, you guys are just as amazing in person.
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Kirby
Thank you.
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Sarah
Usually ask our guests what's on our face, but I would love to know what's in your tummy. What did you eat today?
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Dr. Trisha Pashrika
I had a salad and coffee. So if you hear if the microphone's picking up any rumblings, that's my intestinal gas. Okay.
- [02:09]
Kirby
Oh, love that.
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Sarah
What's like your usual meal for a day? Like, are you trying to balance out the fiber, the protein?
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Dr. Trisha Pashrika
Yeah, I try. I'm obsessed with fiber.
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Sarah
Okay.
- [02:19]
Dr. Trisha Pashrika
As a gastroenterologist, I try to meet women under 50. Should get 25 grams of fiber per day. I fiber maximum. I try to get an A plus. I try to do more than that. So I usually eat some Greek yogurt, some nuts and berries in the Morning for breakfast. That's like super stuffing. Greek yogurt is so stuffing. So I eat that. Then I have salad with chicken. I have like some kind of spicy cashew dressing is my new thing. And then dinner, it's like just all depends. Like, we often have Indian food. We have like lentils, legumes. We might have fish or salmon. And then I'll eat whatever my kids are eating, which is pasta.
- [02:53]
Kirby
I feel like fiber is the new protein. It is. And it's having the come up this year.
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Dr. Trisha Pashrika
Yeah.
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Kirby
Whoever fiber's publicist is, is doing a great job.
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Dr. Trisha Pashrika
I know we failed for like decades and suddenly fiber maxing is so in.
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Kirby
Yes. For a normal person. I mean, you say you're fiber maxing, so I'm thinking to myself, I struggle just to get enough protein in a day.
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Dr. Trisha Pashrika
Yeah.
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Kirby
You know, it's like I see people on Instagram, for instance, chugging a protein shake and then having their fully protein loaded meal and then another protein shake. What does getting enough fiber actually look like?
- [03:24]
Dr. Trisha Pashrika
Yeah, it means that. Well, you know, what I like to do is try to think about it in terms of meals and chunks of my day. So breakfast is actually the best part of your day to get both protein and fiber because the payoffs can. It'll last, it'll keep you fuller and it'll give you energy in that critical early time in the morning. So, you know, most days I think on my own I eat enough fiber, but it's really like, not just like, oh, eat more vegetables. Like, if that were the case, like, it would be easy. I mean, we only have so much room in our stomachs. We're only so full or so hungry. So I try to eat like the highest fiber vegetable I can, so I get the most bang for my buck. Like, I don't play around with like a side suzer salad at dinner because that's not going to get me the fiber. Like, but I do eat a lot of peas, eat a lot of brussels sprouts. These are really high in fiber. And then I eat a lot of legumes. Like in Indian cuisine, we eat a lot of lentils and things those are chock full of fiber. But I'm also going to be honest, like some days I don't meet my goal, but I try to through food. So then I take a fiber supplement and then like just a little bit of fiber supplement gets me across the finish line.
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Sarah
Okay, what's your favorite fiber supplement?
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Dr. Trisha Pashrika
I like psyllium husk. I don't. I mean, I don't endorse any particular brand, but psyllium husk is the main ingredient I look for. And that's soluble, meaning if you put it in water, it will turn into a gel. I put it in my coffee, it will turn into a gel if you don't chug it. So, like, so you have to think about that. But it's that gel that's actually so good for your bowel, so good for your heart, because the gel can trap cholesterol, so it can lower the cholesterol in your blood. Cause you have to protect s'. Mores. So it's great for you.
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Kirby
I happen to have psyllium husk because my dog was having trouble keeping her stool together, and they said psyllium husk in her food.
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Dr. Trisha Pashrika
Did it work?
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Kirby
Yes. And she has it now. And all her food, she has to have it.
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Sarah
Look, Quinn, fiber maxing.
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Kirby
When it's fiber maxing and I'm not, I'm gonna be like, quinn, I'm stealing your fiber.
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Dr. Trisha Pashrika
I'm still young.
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Kirby
Husk. Love that for us. Sharing it with my dog.
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Sarah
I love that.
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Kirby
Love that, my child. You often talk about how the gut is called the second brain.
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Dr. Trisha Pashrika
Yes.
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Kirby
Which. Do you want to explain that a little bit for listeners that may not follow you yet?
- [05:20]
Dr. Trisha Pashrika
Yeah. People think about the gut is just plumbing. It's a brain. So we have this network of neurons in our guts called the enteric nervous system. It is more primitive than the brain in our head. So there are a lot of. I mean, think about a jellyfish, for example. You can picture that translucent little head. There's no brain that you can see, but it's functioning, it's living, it's moving around because it has an enteric nervous system that's making all its decisions. So this developed long, long time before the brains in our heads. But it does act in close communication through the vagus nerve. The vagus nerve is this long information highway that connects the brain to the gut. And if you start to reframe that, your gut is a lot more than just digestion. It's this whole brain that is influencing your hormones, your mood, your immune system. It really changes how you think about your gut and also how you treat it. You know, like, you think about what am I doing every day to protect this brain in my gut, and am I really just going to throw, like, everything that comes my way through, you know, any restaurant that I might pass through, like, right in there and interface with it? It changes that totally.
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Kirby
So for millennial women such as ourselves, who are Juggling careers and family and all of the other stresses that come with life. How does the daily psychological stress physically rewire our gut's ability to function?
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Dr. Trisha Pashrika
Yeah.
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Kirby
Or does it?
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Dr. Trisha Pashrika
Well, stress plays a big role in how our guts move, right? We've probably. I mean, you've described me perfectly. Millennial mom, just picked two kids, career. We've all experienced this day to day, right? Like, acute stress. Suppose you're about to give a big presentation, or if you're, like, nervous because you're on a date, like when you start to feel things like butterflies in your stomach or that, like, pit in the bottom when you're nervous. You know, like, when I was in high school, I did a lot of theater, and, like, if I blew my line, suddenly I'd feel like, why do I have to go to the bathroom right now? Of all things, of all times? Well, it's because acute stress, when you're feeling that way, it causes two things to happen in your gut. One, it causes your stomach to suddenly grind to a halt. That's why people often feel nervous, feel nauseated when they're feeling stressed, because your stomach stops pushing things forward at the same time, it speeds up the last part of your colon. So, I know, ironically, you feel like something has to come up from above, but you also feel like you have to let everything. And that's because it's kind of trying to remove food from your entire gut because you're stressed. And when you're stressed, the lining of your gut becomes a little more permeable. This is a little bit of a different concept from leaky gut, which is, like, taking on its own meaning. But. But it is true that you do have increased permeability, the lining of your gut, when you're acutely stressed. And they've studied this. It's been studied for a long time. So there are a lot of different ways that stress can, in the short term, impact you and cause you to feel ill. But in the long term, we know that it can rewire the gut too. And that's why a lot of people who have been dealing with chronic stress actually get constipated, because those neurons can kind of take on a different phenotype and ultimately lead to slowing down.
- [08:09]
Kirby
When I'm stressed or I'm nervous before I go and give a presentation or I have to be on stage, I always find that if I eat before, I don't have that, or at least I have less of that because I feel like, okay, I'm not also hungry. But is that a bad thing to do or is that actually like a
- [08:26]
Dr. Trisha Pashrika
helpful way to go and everyone has to listen to their bodies a little bit differently because you can certainly push yourself too far. But I think sometimes when people are really nauseated due to stress, eating a little something can actually paradoxically make you feel a little more calm. A lot of times when you're nauseated, the last thing you want to do is eat. But it actually forces your stomach to say, okay, I have to work with this. I have to do a little bit of that motion, that grinding and it can kind of kick start it to move just a little bit. Keep it bland, keep it simple, don't overdo it. But I actually do think it can help.
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Kirby
Yeah, I always just take something that's like very minimal just to get it in me and then I feel instantly a lot calmer.
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Dr. Trisha Pashrika
Yeah, yeah.
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Sarah
We have to talk about bloating. So many people in general experience it and then you know, we're getting targeted all of these like anti bloat supplements. But a lot of women have been told by their doctors that it's just stress induced that just in their heads. How does your research on this brain gut microbiome axis prove that these symptoms are based on real biology?
- [09:22]
Dr. Trisha Pashrika
Yeah, I would say so much in gi, not just bloating, but pain, but diarrhea, constipation. It's very common for women to hear it's due to stress. And we know that stress can certainly aggravate these symptoms and they can even cause the symptoms, but it's not a one way street. And we also know that the GI tract itself, there is a lot of molecular and cellular changes that are the start and the end of the problem. And it's really not all stress, but they will certainly make you more stressed. Now when it comes to bloating, there's really three things that I think about. One, just as a little bit of background, bloating is incredibly common. It's one of the most common complaints people bring to their primary care doctor. It's certainly one of the common ones. I hear when someone comes with bloating, we sometimes try to think about what are the foods that they're eating that could cause bloating and are you secretly constipated whether you self identify or not? So common foods that can cause bloating are like cruciferous vegetables. Those are like broccoli, cauliflower, beans, legumes can do it too. Artificial sweeteners are like the secret killer. Like if you're eating your like zero sugar drink or beverage. They often have artificial sweeteners that are known to cause bloating. Gum, chewing gum is a big one. And then sometimes we know there's like, other things in your environment, like people who use CPAP machines at night. Those sometimes if they're poorly fitted, they can cause bloating. So we often try to figure out if there's something maybe that you're eating or ingesting that could be the issue. There's another group of people where their bloating is due to their bowel habits. And sometimes people, you ask them in this, like, very direct way, and you're like, are you constipated? And they'll be like, no, no, no, I'm not constipated. But then you, like, kind of push and they'll be like, well, I do go once a day, but I strain for like 20 minutes, you know, to go, well, that's constipated, you know, even if you're going once a day. And then when, when you get that, you. You sort of say, okay, maybe there's something else that's things are slow, they're not moving along. But then there's like a third group of people where maybe they've tried to cut out these different kinds of foods that cause bloating. Maybe they feel that they are totally regular. That's not it. In my world, which is neurogastroenterology, there is this third entity, this is a technical term, but it's called abdominophrenic dysentergia. And it's incredibly underdiagnosed and very common. But what that is, is you eat something, it doesn't matter what you eat. It doesn't have to be a food that we think of as causing bloating. And it causes this reflex in which your diaphragm, which is, is this muscle that connects your thoracic cavity to your stomach. It moves downwards. When it moves downwards, think of it like squishing a box. Your abdominal wall has nowhere to go except to push outwards and create this sense of bloating. And the good news about that is that if that's what's going on, and it's very common, you can respond well to diaphragmatic breathing and even physical therapy to try to treat it. And then there's some medications too, that kind of help with the rewiring of the abdominal wall muscles. But it can actually be, like, really nicely treated without you necessarily having to change your diet or change your lifestyle.
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Sarah
When you're fiber maxing or when you're eating a lot of fiber, will you become more bloated? Like, how do you balance that?
- [12:14]
Dr. Trisha Pashrika
You will almost certainly become bloated if you start to fiber max and ramp up from zero to a hundred. So I want everyone to meet their fiber goals, but I never tell anyone to just start doing that tomorrow. Okay? You know, you gotta ramp up slowly because what's happening is your body is, one, not used to that load, and then two, your microbes maybe have been living a certain way for a long, long time before you discovered fiber. Studies have shown it takes about two to three months for those microbes. There's trillions of them living in our colon to turn over and to start to change and react. And when you start to eat more fiber, the point of fiber, just to remind everyone, is actually not to digest it. Right. We, by definition, cannot digest fiber. The point of fiber is to feed your microbiome. And so this is good, this is what you want, but it takes your microbes time to turn over. So go slowly over the next eight to 10 weeks and give your body a chance to respond.
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Sarah
What are your thoughts on lymphatic drainage massages to help with bloating?
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Dr. Trisha Pashrika
I haven't seen any overly convincing data about that. Okay. Yeah.
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Kirby
I mean, they feel nice, but.
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Dr. Trisha Pashrika
Yeah. I mean, some people do abdominal massages even for constipation, too. The data is not overwhelming there. But at the same time, if it's for a massage, like, if you enjoy it, no harm.
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Kirby
Is squatty, potty something that we should all have invested in?
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Dr. Trisha Pashrika
We should have invested in it for sure, because we would have made. That's a separate question. But do we need to be raising our knees above our waist? Absolutely. When we go to the bathroom. Okay, so the colon, it's this long tube, right? And think about at the very end of the colon. The last part of the colon is called the rectum. There's this other muscle called the puborectalis muscle, and it acts like a sling that chokes the colon shut. It is kind of like your body stepping on its own hose and creating this kink. And when we sit at this 90 degree angle, like a chair like position, we're kinking that tube because that muscle, that puborectalis muscle, is really tight. But when we squat, as they used to thousands and thousands of years ago, that tube can straighten out again because that sling relaxes. So the way we've designed modern toilets is like really working against our own physiology. But. And obviously, if. When I start to tell People this, they're like, there's no way in the world I'm going to squat. No, I'm not. I'm not asking anyone to squat. But all you have to do is raise your knees up so you could use a stool. It doesn't necessarily have to be something you paid a lot of money for. It can be like the cheapest thing from Ikea or it can be a stack of books. It could be high heels, like whatever it is, but get your knees up.
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Sarah
High heels?
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Dr. Trisha Pashrika
Yeah, whatever.
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Sarah
Heels in the bathroom.
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Dr. Trisha Pashrika
Don't be surprised if your husband starts.
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Kirby
Yeah, hello.
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Dr. Trisha Pashrika
But it's one of those things that even people who don't have concentrate, like, don't even identify as having trouble going to the bathroom. They've done these studies that otherwise healthy people suddenly find they can poop a lot more easily. So even if you think you're living your best life, you don't have a problem. You might be amazed at what you're missing out on when you start doing this.
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Kirby
Okay, so you talk about this term pooforia.
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Dr. Trisha Pashrika
Yes.
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Kirby
And it's more than just about being regular. It's about thriving on the toilet. What are three fundamental habits women can start today? To move from just surviving in their bathroom to actually achieving true pooforia.
- [15:24]
Dr. Trisha Pashrika
Thank you. I love this. So, yeah, you know, one of the reasons I wrote this book was because this number really struck me. 40% of Americans daily lives are disrupted by their bowel habits. It's not just like, oh, like 40% from time to time struggle like their daily lives are, are disrupted. So this is a big deal. We just don't talk about it. But I think if we were going to talk about like, well, what are the aspects of modern life that are conspiring against us? I think the number one thing is that we are eating too much ultra processed foods. And by process of that, we are not getting enough fiber in our diet. 95% of Americans aren't getting enough fiber. Again, I get that. That is so easier said than done. And I think if you're someone who just like, it's going to be hard to get that amount of fiber. Take the fiber supplement. Take the easy way out, which I myself take so many days a week. Get more fiber. Because that's just how our diets are just designed to not have enough. Use the squatty potty or use some stool to raise your legs up. And then three, don't bring your smartphone into the toilet.
- [16:21]
Kirby
We've learned from our fashion friends that one of the big trends this spring is something called classic coastal.
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Sarah
I am always trying to embrace the classic coastal lifestyle, if I'm being honest.
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Kirby
Why does this remind me of Diane Keaton? And something's got a gift.
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Sarah
Again, like that is. That is the lifestyle for us?
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Kirby
100%. Think crisp stripes, airy linen pieces, that effortless. I might get my own boat Energy.
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Sarah
I say let's. Let's get a yacht.
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Dr. Trisha Pashrika
Wow.
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Kirby
Okay. Dream big.
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Sarah
The nice thing is Macy's makes it really wearable, like clean silhouettes, breathable fabrics, and those nautical details that make everything feel just a little more polished.
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Kirby
Basically, the vibe is relaxed but butt put together, which is exactly how I'd like to look this spring. Head to Macy's to get your classic coastal vibes on.
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Dr. Trisha Pashrika
This one's the hardest to hear. I know.
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Kirby
Oh, my gosh. I was reading that people are getting hemorrhoids from sitting on the toilet too long on their phone scrolling.
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Sarah
I watched one of those. Like, AI, you know, like, don't bring
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Dr. Trisha Pashrika
me to the bathroom.
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Liv Perez
One of those.
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Sarah
It was one of those.
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Dr. Trisha Pashrika
Yeah.
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Kirby
Is this. Do you. Have you found this to be true?
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Dr. Trisha Pashrika
That was my study. That was my study that came out last year.
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Kirby
You're kidding.
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Dr. Trisha Pashrika
Yeah.
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Kirby
This has been covered everywhere, by the way. Congratulations.
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Dr. Trisha Pashrika
Thank you. I know it's like, funny. I study Parkinson's disease. I do a lot of serious things, but this study put my lab on the map. But, yeah, so.
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Kirby
Wow.
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Dr. Trisha Pashrika
Yes. So. And listen, I hear from a lot of parents who are like, how dare you take this from me when I take my phone into the bathroom, it's my only me time. I'm not trying to take that from you. I'm just saying I get it. Like, shut the door, keep the kids out. And then. But just doom. Scroll with your pants on. Like, put the seat lay down. Yeah. And just like, have your me time. But don't. You don't have to do it. Don't strain. The idea is that exactly this straining. The idea is that when you're sitting on an open toilet bowl, it's open. There's nothing that's giving you pelvic floor support. And it's not like, yeah, you do this one time, you're going to get hemorrhoids. But we think that when you do it day after day, week after week, year after year, then eventually the connective tissue around those hemorrhoids weakens. Hemorrhoids are just veins. They're just engorged veins. And those will eventually start to passively fill. And then one day they're going to pop out and be a problem, and you're going to say, how did this happen? And it was actually years of this habit. The smartphone, it's different. Like when I was growing up to see these little discreet bathroom readers. Yeah, the book. Yeah, the book. Like last week's, like, magazines, newspapers that actually, like, nobody has exchanged in a few months. That kind of reading material was not hijacking your brain. It was, like, just enough to distract you, like, maybe make you feel safe, have a nice moment and get out. Smartphones, you will, like, lose. Like, you can watch a whole tv. And people do.
- [19:13]
Sarah
Like sometimes most men do.
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Dr. Trisha Pashrika
They do. I've gone to, like, public bathrooms, and you hear people and I'm like, I know that's the pit that you're watching there. Yeah.
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Kirby
Formula.
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Sarah
Well, oh, my God.
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Kirby
You're like, get out of there.
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Dr. Trisha Pashrika
Yeah. What are you doing? Yeah, Outside the room.
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Kirby
Also use headphones.
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Liv Perez
Yeah, yeah.
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Dr. Trisha Pashrika
It's a pet peeve when people watch these things in public. But in the bathroom, a public bathroom,
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Sarah
of all places, Even worse.
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Kirby
Even worse.
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Sarah
Oh, my gosh. Okay. Talk about period poops.
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Dr. Trisha Pashrika
Yeah.
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Sarah
So you said that 50% of women experience it and then, you know, they feel very alone in it. No one wants to talk about it.
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Dr. Trisha Pashrika
Yeah.
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Sarah
Can you explain the role of prostaglandins in this quote, unquote war zone and why our brains have trouble discerning where that pelvic pain is coming from?
- [20:02]
Dr. Trisha Pashrika
Yes. Okay, so this is really common. A lot of women, the majority, are going to experience some kind of fluctuation with their bowels around their periods. And for a lot of women, it starts as constipation. That's largely driven by progesterone because that also rises and falls according to your period. And it's also the reason why pregnant women who are slowly getting this increasing surge of progesterone, start to get more and more constipated, among other reasons. But then when you're on your period, what's happening is that you get. Every cell in your body produces these compounds called prostaglandins. Prostaglandins are actually what's responsible for your uterus to start to contract and shed the lining. So that's what gives you the period that's unpleasant. Nobody loves this. But what they're also doing is acting on the muscles of your gut, just like they're acting on the muscle of your uterus. And when they do that, they're speeding up contractions and causing things to move. So that's why a lot of women have this problem where they're bleeding and they have diarrhea, and it's the most miserable combination they've ever experienced. And it happens to them every single month. And when this happens and it's really bothersome to people, what I say is like, well, let's try to do something that will nip the prostaglandins in its tracks. Right. Because often when you're on your period and you have a lot of cramps, we take NSAIDs. We take, like, ibuprofen or, like, whatever it is. And in general, as a gastroenterologist, I don't love NSAIDs because they can damage the lining of the gut. If you take too many, you can get an ulcer with them. However, this is true of a lot of medications, but certainly of NSAIDs. In this situation, the sooner you take it, the less of it you'll have to take. And this is, like, true, if you've ever had a headache, if you take that nsaid, like, just to start it, when you have a sense it's happening, it's so, so much easier to treat it than when the prostaglandins are flaring and you're, like, deep in your migraine. Well, it's the same for this. So if you nip it in the bud, you know, you're having the cramps, you're starting, you can actually also help mitigate the diarrhea as well.
- [21:49]
Kirby
So Midol was really a genius marketing format.
- [21:53]
Dr. Trisha Pashrika
Exact same thing. But it's, like, for women.
- [21:56]
Kirby
Exactly. Like specifically for the period. Yes. Brilliant marketing there, Midol.
- [22:00]
Dr. Trisha Pashrika
Way to missed opportunity for that.
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Kirby
I know. Body part 30 years too late. So we, as women have shifting estrogen levels.
- [22:09]
Dr. Trisha Pashrika
Yeah.
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Kirby
So there's perimenopausal transition that we go through and obviously then menopause. But how does that affect our colon and our likelihood to develop ibs? This was a popular question.
- [22:22]
Dr. Trisha Pashrika
Yeah, this is a great question. This is actually getting at the heart of the mechanism behind ibs. Right. Because we know, why does IBS affect more women than men? Like, it's. 80% of cases are women. And interestingly, we. We have a good understanding of what estrogen does in other parts of our body. But in the gut, specifically, estrogen is an important modulator and signal for pain, of all things. And women who have more estrogen receptors and obviously producing more estrogen, we tend to feel more pain in our guts. And for that reason, there had long been this sort of confusing idea where a lot of gastroenterologists were like, we have all of these people who have IBS, young women in their 20s and 30s, and then where do they go when they become 40, 50, 60s? We don't see them in our clinics anymore. What happens and what happens is that the pain naturally starts to get a little bit better because estrogen levels go down.
- [23:19]
Kirby
Interesting.
- [23:20]
Dr. Trisha Pashrika
Yeah. And this has been correlated by epidemiological studies. But actually there was a big paper that was published out of this Nobel laureate out of California who really nailed down this mechanism of estrogen being the mediator for pain signaling. Now, that does not mean that women's GI problems go away as they get older. But to some extent, a little bit of the pain signaling gets better. People start to deal with new bloating, people start to deal with worsened constipation. All of those other things can cause pain in their own way. But it is true that estrogen plays this really unique and odd role and is partially the reason why women experience IBS more than men.
- [23:53]
Kirby
Interesting. So if you think that you're getting better as you get older, but then you have hormone replacement therapy, it could bring it back on.
- [24:01]
Dr. Trisha Pashrika
You are asking the right question. That's the question people are asking now. We don't have the answer. I think hypothetically maybe. I think hormone replacement therapy is one of those things that if you should be on it for other reasons, we don't want to discourage you from it. But this is kind of an open area of research.
- [24:16]
Kirby
Wow. And actually, now that you mentioned research, is it frustrating for you that women in general don't get funded for the issues that we're constantly dealing with? It seems insane that 20, 26, I would love your take on this. What are you personally advocating for and wanting to work on that you're not able to get funded?
- [24:37]
Dr. Trisha Pashrika
Yeah, I mean, it's crazy that 8%, this is a little bit of an older number, but 8% of the NIH funding went towards women's health for like 50% of the population. And obviously this last year, two years, it's been really hard to get NIH funding because of everything going on. And I think it's a two part problem. One, we're not getting the funding that we want. But tragically, a lot of the people who study these issues, these diseases, are women themselves. And like, for example, I'm in GI, this is a male dominated field. More than 80% of the people in this field are men. Most of the patients are women, you know, like an IBS and like some of these issues. But when we don't give People funding, and we're discouraging them from going into research, then the people who suffer first are the female researchers. Researchers, because they're already dealing with so many other pulls and administrative burdens that are disproportionately thrown onto women that we see this in the data that the women are not getting promoted, they're not getting the funding, and then eventually they drop out of those research careers. So it's like a pipeline issue. Like we're, we're discouraging people from even entering the field to study because we can all say, like we, you know, some donor might come up and say, here's like $10 million, study it. But if there's nobody there in the pipeline to take the helm, like then what are we going to do?
- [25:50]
Kirby
Right.
- [25:51]
Dr. Trisha Pashrika
Very frustrating.
- [25:51]
Kirby
Extremely.
- [25:52]
Sarah
So we've been hearing and reading all these studies that have been saying there is this rise of colorectal cancer in younger populations. What are the specific red flag symptoms that we should never ignore? It's just ibs.
- [26:07]
Dr. Trisha Pashrika
Yeah, yeah. One, I think it's really important to find a doctor who you trust, most importantly, who trusts you. And with ibs, I feel like that's sometimes hard to find, you know, or being honestly just being a woman. Yes, thank you. That's really hard. Like just frustrating. But you want somebody who, when they tell you they are reassured, you believe them and they have taken you seriously, they've looked into it seriously. And if you feel like you want more help, more answers and you're not getting it, like the first thing I would say is you have to get a second opinion. However, the red flags that we should look out, any kind of bleeding. Okay. Bleeding, bright red blood, maroon colored blood, black stool, like the color of this microphone. That's a big red flag. Pain that you can't explain. Like if you've had pain, you've been diagnosed with IBS because somebody has done the appropriate test, they've already looked at the colonoscopy, they've done blood tests and they said this is ibs. That's reassuring. If they've done the right testing, if you haven't had those tests and they've, they're just saying, no, no, this can't be anything else. We have to push a little harder. Iron deficiency anemia. This is a big one for women because this is not a diagnosis. You can make yourself a doctor has to say, okay, why are you so fatigued? Why is your energy low? Let's check a blood test. And then they surprise find that your blood counts are Low. And when you're a woman, the most common thing that you. That is true is that it might be due to losses from your period if you have heavy period. But if someone tells you that and you're like, wait, I don't even have heavy periods, you know, and like, it doesn't add up and you have any of the other symptoms, you have to, you have to think about it. And I think, you know, when we think about red flag symptoms, that word makes me think that we're waiting for something to rise to the level of an emergency, to seek care. And especially when you're young, you don't want to see your doctor unless it's. Unless you really have to. Right. And frankly, a lot of people don't have primary care doctors or it's very hard to get those appointments. But what we've seen with colorectal cancer in younger patients, and that's younger than 50, younger than 45, is that we're diagnosing them later. Both because people delay seeking care and then because the doctors are not quick enough to say, wait, could this be something more? And so I tell people, just shoot a quick. Like, I'm a gastroenterologist. If someone sends me a picture of their poop and they're like, is this weird? I love it. Like, send it.
- [28:19]
Sarah
Dr. Trisha, your DMs.
- [28:20]
Dr. Trisha Pashrika
Right now I have to use electronic medical record. Yes. I have got through a portal. Yeah, let me be so clear about that. But like, send it. Get the reassurance. Just get your doctor to say, actually, you know what, I'm not worried. Or let's watch it. Let's just like, keep an eye on it for two more weeks and see what happens. But have a low threshold. Don't wait for an emergency.
- [28:37]
Liv Perez
Right.
- [28:38]
Sarah
So I'm 39. My mom was diagnosed with colon cancer last year, but had a very successful surgery. Is cancer free.
- [28:46]
Dr. Trisha Pashrika
Oh, my gosh. Glad to hear.
- [28:47]
Sarah
Very, very lucky.
- [28:48]
Dr. Trisha Pashrika
She did well.
- [28:49]
Sarah
She did well. But, you know, so now I am watching myself and my doctor suggested that I get a colonoscopy at 40.
- [28:56]
Dr. Trisha Pashrika
Yeah. So.
- [28:57]
Sarah
So the colonoscopies are typically recommended for when you're 45.
- [29:02]
Dr. Trisha Pashrika
Yes.
- [29:02]
Sarah
What are your thoughts on that?
- [29:04]
Dr. Trisha Pashrika
Yeah, well, 45 for someone at average risk. Since you've had a family history, since your mom has been diagnosed, you're no longer considered average risk. You should get started earlier. And usually the rule, and there may be other factors in your case, but usually the rule is 10 years before the age of that person in your family. So, and I'm gonna make this up, but if your mom was 49, then you should start at 39, not 45. Okay. And then afterwards you'll be screened more frequently. If someone of average risk comes and their colonoscopy looks clean, we'll say, okay, come back in seven to 10 years. If you have a family history, we tell you to come back more often. So you're going to be on the five year plan probably. Okay. But I also think what's really important about this is that a lot of times people who come to my clinic, I'll be like, so who in the family has GI issues? You know, who has who's colon cancer? And they'll be like, oh gosh, you know, my, my uncle had some kind of cancer, but I don't know what it was. And they certainly don't know what age uncle had that cancer. And these two questions, where was the cancer? What age were they diagnosed? Can really change your health. It'll change when you get screened. If you had an uncle and a nephew who had colon cancer, then I'm going to start screening you early. That's two second degree relatives. If you have one first degree relative like a sister, I'm going to start screening early. So you really have to the next family gathering, ask everybody not just who had what, but what age were they diagnosed. Yeah.
- [30:14]
Sarah
Okay, so next Thanksgiving.
- [30:16]
Kirby
That's a great tip.
- [30:17]
Dr. Trisha Pashrika
No, we'll do it Easter. Don't waste.
- [30:19]
Kirby
Right.
- [30:19]
Dr. Trisha Pashrika
Okay.
- [30:19]
Sarah
One of our listeners asked about cologuard. So this is like an at home kit?
- [30:24]
Dr. Trisha Pashrika
Yes.
- [30:25]
Sarah
What are your thoughts on that?
- [30:26]
Dr. Trisha Pashrika
So I love cologuard for anyone who can't get the colonoscopy. So what the cologuard is is this box that'll come to you discreetly in the mail. There's no like labels that tell you what it is. And then you poop into this little kid, it's very clean. And then you mail it back and then great. And then in like a week you get the results. Do you have cancer? Do you not? It does a great job at screening for cancer. The reframe I want people to just remember though, is that the colonoscopy is not there to detect cancer. Like, yes, we will detect cancer through a colonoscopy, but the colonoscopy prevents cancer. None of these other tests do that. The cologuard test and there's a blood test now too. They're very good at screening, but they're not so good at picking up those early polyps. Polyps are these growths that develop in our colon. The majority of us are going to get polyps over the course of our lifetime. The colonoscopy gives you and your doctor a chance to go in and just snip them right out before they ever become a problem. And we know 5 to 10% of polyps will go on to become a cancer. So the colonoscopy, if I can convince anyone to do that, I want to convince them to do that. There are other people who can't do the colonoscopy for any number of reasons. Sometimes you can't get a ride home. That's actually like really hard for people. Sometimes there's. There, there's risks with anesthesia. You don't actually need anesthesia, but we, that's typically how we do it here. So if you can't do it for any number of reasons, then any test is better than no test. Then definitely get the stool kit. It's the easy option. But I don't want people to walk away thinking it's just as good or it's the same thing as the colonoscopy. Because if that was the case, sure, we'd all pick the stool kit. Like, why would we not, right?
- [31:52]
Kirby
How have GLP1s affected your work?
- [31:55]
Dr. Trisha Pashrika
I love GLP1s. They don't. And this is also like a surprising thing because as a gastroenterologist, people are like, you must hate them. There were patients come to me and they'll say, my primary care won't prescribe this until you give the green light. And I'm like, why are you waiting on me? Like you have the green light. Like there's, you know, this is a wonderful thing, knowing full well they cause a lot of often very unpleasant GI side effects. But there's a couple things to note about that. One, the reason I'm so enthusiastic about them is because, I mean, there's a few other things that can help with metabolic syndrome, but they also specifically help your gut in ways that are not obvious. Because all we think about when we think about the gut and GLP1s are like, they cause really bad nausea, they cause constipation, they are actually associated with reducing your risk of colorectal cancer. And that's because we think the underlying mechanism of GLP1s is anti inflammatory and inflammation is one of the big promoters of cancer. So it's not just colon cancer, it's like 12 different cancers that they can help reduce. So that's one. My lab studied how GLP1 medications can reduce your risk of getting ulcers in your stomach because they're protective on that lining of your stomach. So when I'm counseling someone about GLP1s, I usually tell them, let's anticipate that you're going to have GI symptoms. Let's assume you're going to get constipation, and why don't we just start doing something early and intervene? Maybe it's just as simple as taking a fiber supplement. Let's start there. The kind of good news about it is that most people who get GI symptoms, and not everyone, some people have severe symptoms, but most of them are mild to moderate, and most of them peak early. Like, the worst GI symptoms you're going to get are in those first couple days to weeks. And then once you've found your steady dose and you're on that for a little while, the GI symptoms actually tend to get better. So if you can stick through it, then the benefits you're going to get from a GLP1, if you're a good candidate, are usually, to me, vastly outweigh the risks.
- [33:38]
Sarah
Totally amazing.
- [33:40]
Kirby
All right, so we have some listener questions. What is the biggest digestive myth people believe?
- [33:45]
Dr. Trisha Pashrika
People believe that you have to go once a day. And I don't know. I mean, I think I have a hypothesis about why that number one is like the number one for number two, but I don't think it's grounded in reality. You can go as many times a day as you feel comfortable, and I would still call you normal. They did this big study where they found that if you go anywhere from once every three days, which to me sounds pretty infrequent, to three times a day, which to some people must sound very frequent. All of that's within the range of normal. It's very healthy for a typical American lifestyle and diet. So just because you're not going once a day doesn't mean that you're weird, doesn't mean that you're off. And I guess, conversely, just going once a day, but you're straining your eyeballs out and your partner's like, we are 50 minutes late. Like, what's happening? That's not normal either, you know, and so what's normal? And this is just a big myth, what is normal should be what is comfortable for you. It should be effortless, and it shouldn't cause you any social distress.
- [34:38]
Sarah
Okay, got it.
- [34:39]
Dr. Trisha Pashrika
Okay.
- [34:40]
Sarah
Are people misdiagnosing themselves with gluten intolerance?
- [34:44]
Dr. Trisha Pashrika
That is a big. Yeah, that's also another myth. So gluten intolerance is a real thing. I'm going to start there. I think a lot of people feel like that's a kind of label that gets dismissed because it's not real or there's not a test for it. It is a real thing, but what's driving it is a little bit more unclear. And sometimes, at least some of the studies have shown that what you perceive to be a gluten intolerance because you're eating products that contain gluten, and then you feel symptoms, it might be a different compound. It might be the fructans, which also go hand in hand with a lot of the products that have gluten. And it turns out if you find out that that's what the intolerance is, you can kind of open up the door a little bit to eat a more liberalized diet. Like maybe you could tolerate sourdough bread, for example, but if you thought gluten was a problem, you wouldn't have been able to. So if somebody has concern that they might have a gluten intolerance, I usually tell them to talk to a gastroenterologist and. Or to a registered dietitian. So we can actually just confirm that really it's the gluten and not some other compound.
- [35:38]
Kirby
Okay. And lastly, when I'm bloated, this is from.
- [35:42]
Dr. Trisha Pashrika
This is not my first. Yeah, we're not talking about anyone in particular right now.
- [35:45]
Kirby
When I'm bloated and I need immediate relief, is it better to take a digestive enzyme or something like gas X? How do you feel about gas X?
- [35:54]
Dr. Trisha Pashrika
I feel good.
- [35:54]
Kirby
Okay.
- [35:56]
Dr. Trisha Pashrika
I feel like. Okay, so this is like a. A great question, because it depends on, like, what's driving the bloat here. You know, like, gas X is going to get it. One form of it, digestive enzymes. So in general, if we think about what digestive enzymes are, they're breaking down usually, then every formulation might be different, but they often contain enzymes that are designed to contain enzymes you and I don't make. On our own, they're breaking down things like fiber, which we actually don't know how to break down. Our bodies don't do that, but they'll give you the enzymes that do it. So, yes, that will relieve your bloating in that case. But at the same time, if you just took, like, a little step back, we don't want to break down the fiber. We want our fiber to reach the colon. And so if you're feeling bloating, like. So if you need something in a Pinch, feel better, take the digestive enzyme, if that's worked for you, if that's the issue. But maybe we take a step back and say, how do we get you to be able to eat the foods that you need and that you love, but have also like a long term solution that's not kind of like stimming ourselves?
- [36:52]
Sarah
What are your thoughts on not just like probiotic supplements, but like, now we're seeing all these gummies.
- [36:57]
Kirby
Someone else asked this. Someone was very curious about probiotic gummies, but also probiotic drinks.
- [37:03]
Sarah
Yeah, like poppy.
- [37:05]
Dr. Trisha Pashrika
Yeah, yeah, I know, I know. Let's add that to our list.
- [37:11]
Kirby
Another thing we did not invest in,
- [37:12]
Dr. Trisha Pashrika
so I interrupted you. I know gut health. There's a lot of products out there. I mean, there's a whole industry, gut health specifically, that is sort of like people have severe symptoms that are misunderstood and they're looking for answers. And it's very profitable to make these products. The data is not great. The data is not great for almost any form of probiotic supplement that's not naturally present in a food. The data is incredibly good for probiotics that are naturally there in foods like Greek yogurt, like kombucha, like even a little bit of soy sauce, like has it. But if somebody's looking to optimize their gut health, the answer is never a probiotic soda. The answer is almost always eat more fermented foods, eat more probiotics, eat more prebiotics, which are like the fibrous foods.
- [37:54]
Kirby
The refrigerated probiotic supplements are also not great.
- [37:58]
Dr. Trisha Pashrika
They're being refrigerated so that, that has this like, sheen of like, oh, it must be live bacteria that they're keeping shelf stable. But. And you know, the whole problem with probiotics is that what you think you're doing is like, if your microbiome is discovered garden, you think you're sprinkling some good seeds into that mic, into that garden, and half the time those seeds die, like as they're acidified in your stomach and they never make their way to the garden. And then the other thing is that maybe they make it to the garden. Who's to say that what's growing in there is just because you had the wrong seeds? Maybe what's growing in there is because the soil was no good, the ph was off, you didn't have enough sunlight. And again, that's where the probiotic foods and the prebiotics really come in.
- [38:36]
Kirby
Excellent point. Dr. Pazricha, thank you so much for coming. Your book, you've been pooping all Wrong. Comes out April 7th. Where can we find it?
- [38:46]
Dr. Trisha Pashrika
Anywhere you get your books.
- [38:48]
Kirby
Thank you.
- [38:59]
Liv Perez
Hey, this is Paige Desorbo from Giggly Squad, and this episode is presented by Depop. Okay, be honest. How many things in your closet are just sitting there waiting for their next main character moment instead of staring at them, list them. You can list an item in just a few taps on Depop. Snap a photo and their AI powered listing fills in the details and you're done. It's not giving stressful and it's giving efficient and make money easily. With no selling fees on Depop, no seller fees means what you earn is yours. Your personal taste has value. Someone is literally looking for what you're not wearing. Download the Depop app and list your first item today.