Regina Barber (2:05)

Later today on the show, for your health and happiness, let's make pooping less taboo. A medical doctor shares what every person should know about going number two. I'm Regina Barber and you're listening to Shortwave, the science podcast from NPR.

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Regina Barber (3:52)

day doesn't stop, and neither do we. Whether you're starting your day or finishing a commute, we're right there with you. The NPR app has global and local news, plus hours and hours of this podcast ready and waiting for you. Download the NPR app today. Okay, back to the show. Okay, so Dr. Tricia, can I call you that, please? Dr. Tricia, you wrote that the heart of why people are pooping wrong starts with the fact that as a society, we do not talk about pooping. I mean, other than me, I talk about pooping all the time. We're trying to change that today, starting with like, how are people pooping wrong?

Dr. Tricia Pasricha (4:33)

Well, I think that people don't have a good framework for how to poop. And so I think about it in terms of three things and I call these the three Ps. But one, I think that pliability is off and that is how basically how soft or pillowy that poop is.

Regina Barber (4:50)

Pliability, more fiber.

Dr. Tricia Pasricha (4:52)

Often, but not always, but often the issue is fiber. And truthfully, 95% of Americans, we are not meeting our fiber goal. So like, more often than not, you need more fiber. Propulsion is the other Problem. Propulsion refers to how your muscles are generating these contractions in your own gut to push that poop forward. So that's the second p. And then the third mistake that that can come into play is in our pelvic floor. And I think this is the most underappreciated part of it. Like, we were often like, oh, yeah, we need more water. We need more fiber. How many of us are asking, what is my pelvic floor doing? And the pelvic floor is this complex set of more than a dozen muscles that kind of hold all of our internal organs together and kind of the floor of this box and pair. Very paradoxically, when we bear down to have a bowel movement, we're building up all of this pressure in our chest cavities, but we're asking our sphincters to relax in that critical moment. And it's actually kind of counterintuitive to what the rest of our bodies are doing.

Regina Barber (5:52)

And when we're talking about the pelvic floor, it's important to remember that everyone has one, right?

Dr. Tricia Pasricha (5:56)

Yeah, you're exactly right. Sometimes when I suggest to people you might need pelvic floor pt, a lot of the men are like, wait, what are you talking about? Like, that's. My wife got that when she gave birth. That's a different kind of pelvic floor PT or physical therapy than what I'm talking about for constipation. Constipation. It affects men and women, and we sometimes just develop these problems where those sphincters clench instead of relaxing at the critical moment. And so it's like trying to squeeze toothpaste out of a toothpaste tube, but you never take the cap off. And sometimes when you can just retrain those muscles, finally, it's like taking the cap off that tube, and suddenly the toothpaste comes flying out. But the whole issue was never that you needed more water or that you needed to soften the toothpaste. You just needed to open that door.

Regina Barber (6:37)

I love it. I love the analogy. So I have the quintessential question that everyone has been asking. The most controversial pooping topic. To squat or not to squat. What's the case for squatting?

Dr. Tricia Pasricha (6:54)

Squatting. You know, if you go to a daycare and you look around at all the kids in their diapers who are potty training, and one of them has to poop, what did they do? They drop the deepest squat you've ever seen in your life, and they go. Physiologically, squatting is the correct way to go. And this Comes back to our pelvic floor, which we always underappreciate. We don't think about. There is this muscle in our pelvic floor called the puborectalis muscle. And that muscle forms a sling around our colons, almost like our body stepping on its own hose. It, like, creates this kink that causes this block. And that block is present when we're just sitting down, as you and I are right now. But when we squat, that pupa rectalis muscle relaxes, and the tube straightens out again. So we're able to go and push things out effectively. If we're not squatting, we just have to generate a lot more force. Now, I don't think that anybody is gonna go back to squatting. We used to do that thousands of years ago. Nobody wants to do that in the comfort of their own homes.

Regina Barber (7:58)

Well, I mean, there's a lot of places around the world that do still have the squat toilets. Right. Where it's like a beautiful porcelain. You know, you put your feet. Yeah.

Dr. Tricia Pasricha (8:07)

Like, little hole on the floor. Yeah, yeah, yeah. Oh, I've seen those. I've lived those.

Regina Barber (8:12)

So some people still love squatting.

Dr. Tricia Pasricha (8:14)

And those people are onto something. And actually, I'm sure they have, like, better balance than a lot of us have. But if you're not ready for that, or you just, like, are going to say, like, there's no way I'm going to swap out my toilet in my house for one of those porcelain holes, then you can do the bare minimum, which is just to raise your knees above your waist. You just need a stool, or you need a stack of books or something that you can lift your knees up on. And people who don't even identify as having constipation, just like healthy people, once they do this, even, they say, oh, my gosh, wait a minute, this is way easier to go than before. And they've studied this, that even healthy people find that lifting their knees up allows them to go more easily. And this is a great example of that. You actually could be doing a lot better in so many ways than you think.

Regina Barber (9:01)

Yeah. Like, I'm gonna go out and get a stool, like a squatting stool for my toilet, like, tomorrow, honestly.

Dr. Tricia Pasricha (9:08)

Yeah. Your life will change. It will.

Regina Barber (9:11)

And you said in the book that because a lot of us in the western world, you know, have these seat toilets, and we've been conditioning our body and our pelvic floor, and it's actually not good for us. Is that right?

Dr. Tricia Pasricha (9:25)

Yeah. Modern life has done us this disservice and there are a lot of people who like, need that seat because balance is really, really hard. But for a lot of people, we've made a moment that actually shouldn't be that comfortable. Like, we shouldn't be so relaxed that we should be able to just watch an episode of the Pit on our phones while we're doing this other job. Like, if you had to squat in like this porcelain hole on the ground, how many of us would be pulling out our smartphones and relaxing? None of us. We would all just get in and we would get the heck out of there.

Regina Barber (9:56)

But we'd pooping better.

Dr. Tricia Pasricha (9:57)

We'd have fewer hemorrhoids, we'd probably be happier people. But we've kind of turned it into this little mini spa because that chair could be pretty comfy.

Regina Barber (10:06)

Totally. So I think we should circle back to this first P that you mentioned. Pliability. And I think you're right that like, when people do stop to think about how to poop better, they think of fiber to soften the stool. So how much fiber should I or everybody be getting each day?

Dr. Tricia Pasricha (10:23)

Yeah, for women under 50, it's 25 grams per day. And men under 50, it's 38 grams per day.

Regina Barber (10:30)

And what does that translate to for food? Like, what's your favorite fiber filled food?

Dr. Tricia Pasricha (10:35)

I like to fiber max my vegetables. Meaning, like, I mean, we all can only eat so much in one day, right? And so at dinner time, I try to eat like the highest value vegetable I can. Like if I'm making fish or pasta or something, I will eat peas or I'll eat like Brussels sprouts. Like, I just try to like really eat an adult vegetable when I'm having like vegetables. And so like, I, I guess like my favorite ones. I do love peas because peas are like, these are not for the weak. Right? Like, they have so much fiber and they will. Yeah, they'll destroy you if you eat too much of them. But it means, like, you can very quickly meet your fiber goals without, like eating a ton of stuff that you weren't going to do anyway.

Regina Barber (11:19)

You talk about kiwis in your book. If you have two a day, you're good.

Dr. Tricia Pasricha (11:22)

Yeah. Within the last about five years, two excellent randomized controlled trials have shown that kiwis one, yeah, they have a great amount of fiber, but they specifically help with bloating and constipation. They're actually even better for bloating than prunes.

Regina Barber (11:37)

They taste better.

Dr. Tricia Pasricha (11:39)

Taste better. I actually make my son, he's 2 years old, he eats kiwis every day. He loves them. We don't have a constipation problem there.

Regina Barber (11:45)

I don't eat the skin. I just eat the fruit. Just.

Dr. Tricia Pasricha (11:49)

Oh, okay, okay. That's gonna be your challenge then in your homework, you have to eat the skin. You don't have to. Okay, calm down, everyone. You don't have to. My son does not eat the skin.

Regina Barber (11:59)

But it's even better if you eat the skin is what you're telling me. Yeah.

Dr. Tricia Pasricha (12:02)

I mean, you're only gonna get more fiber, more nutrients.

Regina Barber (12:04)

Fair, Fair. Okay. And it would help counteract my anxiety, which you write, can also harm people's ability to go number two. Which leads me to this last question. Can we think away some of our gut problems?

Dr. Tricia Pasricha (12:16)

You can, to say some extent, find that your stress, your anxiety, and your depression are closely mirrored by what your bowels are doing. But also know that the opposite is also true, that your bowels, what you eat and how you treat them will also influence your anxiety and your depression and your stressed in a lot of ways like these. It's funny that, like, when it comes to the gut and the brain, so many of the same things that are good for the brain in your head are the same things that are good for your gut. And that's because the physiology, in a way, is very similar. Right? Like eating high fiber diet is excellent for your gut, it's excellent for your brain and mood, partially because of the microbiome that then produces these new compounds based on that fiber that can get absorbed in your bloodstream and make their way up to the brain. Exercise is wonderful for your gut, it's wonderful for your brain and for your mood. And so these two things can be really closely linked if you're in a moment of high stress. If you activate your vagus nerve, that is going to calm you down, it's going to lower your heart rate. So there's a couple of different ways you could activate the vagus nerve. One of them is box breathing. Box breathing is where you can imagine you're going to draw a box with your hand, and you might inhale 1, 2, 3, 4, up the side of a box. And then as you draw the next side, you're gonna hold it. 1, 2, 3, 4. Now you go down the other side, 1, 2, 3, 4. As you exhale, then you hold it, 1, 2, 3, four. And you close the box. And if you do that two or three times, that activates the vagus nerve and your heart rate comes down, those cramps disappear, and all of it kind of gets better.

Regina Barber (14:02)

But what a calming way to end this show. Tricia. I didn't expect that. Thank you so much for coming on our show and talking to us about fiber and the merits of squatting and hopefully helping all of our listeners figure out how to poop. Even better.

Dr. Tricia Pasricha (14:20)

Thank you.

Regina Barber (14:21)

If you like this episode, do us a favor and share it with the first friend you thought of when you heard you were pooping all wrong. It really helps our show and hopefully it'll help them too. This episode was Produced by Burleigh McCoy and edited by our showrunner, Rebecca Ramirez. It was fact checked by Tyler Jones. The audio engineer was Jimmy Healy. I'm Regina Barber. Thank you for listening to Short Wave from npr. Do you want to hear a diarrhea joke?

Dr. Tricia Pasricha (14:46)

Of course I want to hear a diarrhea joke.

Regina Barber (14:48)

Did you know that diarrhea is hereditary? No. It runs in your genes.

Dr. Tricia Pasricha (14:54)

Oh my God. I was gonna say it runs in the family, but runs in the jeans is like two times better.

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