Bowel Movements, Fiber and Why Cancer Rates are Rising in Young People with Dr. Trisha Pasricha

Summary

Podcast Summary: "Bowel Movements, Fiber and Why Cancer Rates are Rising in Young People"

Podcast: That Can't Be True with Chelsea Clinton
Host: Chelsea Clinton (Lemonada Media & The Clinton Foundation)
Guest: Dr. Trisha Pasricha (Harvard Medical School gastroenterologist, Washington Post columnist)
Release Date: October 30, 2025

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Episode Overview

This episode addresses public confusion and misinformation around gut health, bowel movements, colon cancer, and the rapid increase in cancer rates among young adults. Chelsea Clinton interviews Dr. Trisha Pasricha, a leading gastroenterologist, journalist, and upcoming author (“You’ve Been Pooping All Wrong”) to separate fact from fiction regarding at-home colon cancer screening, the impact of diet (especially fiber), the gut-brain connection, and how to develop healthier bowel habits.

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Key Discussion Points & Insights

1. Gut Health & Bowel Movements: What’s “Normal” and Why It Matters

• Destigmatizing the Conversation:

  • Dr. Pasricha grew up in a gastroenterologist household where discussions about bowel movements were routine (03:15). She notes that, while many Americans feel awkward talking about gut health, about 40% of people think about their bowel habits every day.

  “Half of what I do is trying to destigmatize talking about our bowel movements, talking about poop.” — Dr. Pasricha [06:33]

• Assessing Bowel Health:

  • Key questions: Are your bowel movements comfortable and regular? Do they cause stress? Are you spending more than 5 minutes in the bathroom? (05:13)
  • Disruptions or preoccupations about pooping can reflect deeper issues (05:49).

  “If you don’t feel that you have a healthy relationship with your gut, even if you don’t have a medical diagnosis, that’s a time to check in.” — Dr. Pasricha [06:00]

2. Screening for Colon Cancer: Colonoscopy vs. Stool Kits

• Colonoscopies as the Gold Standard:

  • Colonoscopies do more than detect cancer—they PREVENT it by removing pre-cancerous polyps (08:29).
  • At-home stool kits (like Cologuard) are great at detecting existing cancers (about 92% sensitivity) but do not help prevent cancer.

  "The colonoscopy is what I'd want for myself. It's what I'd want for my family." — Dr. Pasricha [08:29]

  • Colonoscopy is best if feasible, but “the best test is the one that gets done” for those unable to have a colonoscopy (09:58).

• Accessibility and Social Support:

  • Many people only keep up with screening because a loved one prompted them; regular screening is a preventative act of self-care and care for others (16:35).
  • Heartfelt anecdote: A reader commented that her late father delayed screening for years and lost his life. Dr. Pasricha considers this a cautionary tale she often remembers (16:35).

3. Rising Rates of Early-Onset Cancer: Causes and Prevention

• Environmental and Lifestyle Factors:

  • Genetics and smoking are historic culprits, but the rise in cancer among young people relates more to environmental and lifestyle changes (11:25).
  • Top lifestyle factors identified:
    1. Alcohol: No safe level regarding cancer risk, contrary to outdated beliefs (12:29).
    2. Diet/Ultra-Processed Foods: High consumption linked to cancer; lack of replacement with high-fiber foods is a significant risk (12:29).
    3. Sugar-Sweetened Beverages: Greater childhood intake correlates with early-onset colorectal cancer (15:28).

  “There is no amount of alcohol that is safe for you when we’re talking about cancer.” — Dr. Pasricha [12:53]

• Fiber and Preventive Nutrition:

  • Fiber intake is grossly insufficient among Americans (over 95% don’t meet recommendations: 25g/day for women, 38g/day for men) (13:25).
  • Whole grains, fruits, veggies, legumes, and dietary diversity are emphasized.
  • If changing diet is difficult, Dr. Pasricha suggests a psyllium fiber supplement as a practical step (14:00).

  “Changing your whole diet is really hard. Add a fiber supplement every day.” — Dr. Pasricha [14:00]

• Meat Intake and Cooking Methods:

  • Red and processed meats are linked to colorectal cancer. Even small steps like introducing “Meatless Mondays” or marinating meat (cuts carcinogens by 88%) help (14:36).

• Hopeful Message on Change:

  • It’s not too late—lifestyle adjustments at any time can reduce risk (16:27).
  • Blaming individuals is not constructive—many risks are outside personal control, especially those rooted in environment or childhood (16:35).

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4. Kids’ Health: Setting the Stage for Lifelong Gut Wellness

• Early Dietary Habits:

  • Dr. Pasricha emphasizes forming children’s palates early and boosting microbiome diversity by centering veggies and protein, not just carbs, at meals (21:29).
  • She advocates for minimizing sugary pouches and instead uses a variety of produce, frozen if necessary (22:52).

  “Frozen fruits and vegetables have an exactly comparable nutritional value.” — Dr. Pasricha [23:07]

• Key Pediatric Guidance:

  • Focus on fiber and variety to support a diverse microbiome, the foundation of gut and overall health (23:53).

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5. Microbiome and Fermented Foods

• Defining the Microbiome:

  • The microbiome is “like a garden inside your gut” — trillions of microbes living in symbiosis (24:08).
  • The science on direct manipulation (e.g., probiotics) is still developing, but dietary fiber and fermented foods reliably support a healthy microbiome (24:28).

• Fermented Foods Matter:

  • Foods like pickles, kimchi, sauerkraut, Greek yogurt, and dosa (Indian fermented crepes) are associated with greater microbial diversity (26:04).

  “If we can take you out of that 95% into the 5% [who meet fiber goals], I will feel that we’ve won.” — Dr. Pasricha [27:21]

• Antibiotic Use:

  • Don’t fear medically necessary antibiotics; the microbiome is resilient and typically recovers in three weeks (29:07).
  • Probiotics may help children during antibiotics but aren’t strongly recommended for healthy adults (29:08).

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6. Gut-Brain Connection & Beyond

• The Two-Way Street:

  • The conversation covers classic examples of brain-to-gut effects (stress-induced GI symptoms) and recent science showing 90% of gut-brain signaling goes from gut to brain (32:50).
  • New research: Gut health may play a role in diseases like Parkinson’s, anxiety, depression, and possibly heart and mental health (33:00).

  "The first step of digestion begins in the brain. It's called the cephalic phase of digestion." — Dr. Pasricha [31:54]

• Important Red Flags:

  • New, persistent GI symptoms (rectal bleeding, abdominal pain, new diarrhea/constipation, iron deficiency anemia, postmenopausal bloating) require prompt medical attention for possible cancer or other serious disease (35:34).

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7. Inflammation, Leaky Gut, Wellness Trends, and Misinformation

• Inflammation:

  • Chronic, low-grade inflammation is over-hyped as a root cause for everything, often in pursuit of profit (“tests that will tell you how inflamed you are...are not validated”) (38:49).
  • Inflammation is real and disease-associated but is more a symptom than an underlying cause in many chronic illnesses (40:52).

• Food in Europe vs. US:

  • The idea that people tolerate pasta/bread better in Europe is not solidly explained by science; hypotheses (processing, wheat type, pesticides) remain unproven (41:04).

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8. The "Ask A Doctor" Column and Social Media Wellness Trends

• Common & Wild Reader Questions:

  • Most common: Readers submit specific, personal medical questions, reflecting a lack of access to primary care and trust in doctors (43:45).
  • Wildest: Trend-driven questions from social media (e.g., "mushroom coffee") force Dr. Pasricha to stay up-to-date on online health fads (42:43).

  “People don’t have a doctor that they feel they can trust.” — Dr. Pasricha [43:47]

• Digital Misinformation:

  • Gen Zers may trust online information more than their doctors, underscoring the importance of clear, evidence-based online health guidance (44:47).

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Memorable Quotes & Timely Highlights

• On Colon Cancer Screening:

  “The colonoscopy is what I would want for myself. It’s what I’d want for my family members.” — Dr. Pasricha [08:29]

• On Alcohol and Cancer:

  “There is no amount of alcohol that is safe for you when we’re talking about cancer... No safe amount when we’re talking about dementia risk.” — Dr. Pasricha [12:53]

• On Fiber:

  "More than 95% of Americans are not meeting those [fiber] goals." — Dr. Pasricha [13:54]

• On Self-Guilt and Cancer Prevention:

  “There should be no sense of self blame when we’re talking about cancer risk.” — Dr. Pasricha [16:35]

• On Microbiome Diversity:

  “If you want to go—my first step is high fiber...but let’s not sleep on the fermented foods.” — Dr. Pasricha [27:21]

• On Antibacterial Fears:

  “Your microbiome is incredibly resilient. It will bounce back within about three weeks.” — Dr. Pasricha [29:07]

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"Fact or Fiction" Segment (Rapid Fire Science Debunks)

[45:23-54:56]

• Reading on the Toilet: Harmful?
  • Fiction (unless you’re on your phone for too long, which increases hemorrhoid risk) [46:10]
• Pooping Once a Day is “Normal?”
  • Fiction: “You should have a bowel movement as often as feels comfortable for you.” [46:51]
• Are Some Toilets Better?
  • Fact: Bidets are better for hemorrhoids, postpartum, mobility, etc. Heated seats are a luxury bonus [48:24]
• One-ply or Two-ply?
  • Expert Opinion: “Everybody deserves two-ply.” [49:33]
• Leaky Gut Syndrome: Curable?
  • Misunderstood/Misused: Leaky gut exists biologically (intestinal permeability), can be influenced by stress, NSAIDs, alcohol, but is a symptom, not the direct problem. No validated clinical test. [50:24]
• Filtered vs. Unfiltered Coffee:
  • Fact (sort of): “Drinking filtered coffee is associated with a mortality benefit.” French press/espresso in high amounts can raise cholesterol. [53:38]

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Notable Light Moments

• Dr. Pasricha’s playful advocacy for bidets and two-ply toilet paper.
• Chelsea Clinton’s relief at learning coffee isn’t a gut health villain.
• The “toilet reading” study updates.
• Bidet chat: “The heated seat is the luxury. The bidet is the necessity.” — Dr. Pasricha [48:24]

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Timestamps for Important Segments

• Introduction, Dr. Pasricha’s Background – [00:06–03:15]
• Are We Pooping All Wrong? – [03:15–06:33]
• Colon Cancer Screening Debate – [06:48–09:58]
• Rising Cancer in Young People: Why? – [11:25–13:59]
• Fiber, Diet, Red Meat & Sugar Beverages – [13:17–16:27]
• Hope for Change & Screening Motivation – [16:27–19:28]
• Kids & Microbiome Basics—Parent Tips – [21:11–23:53]
• Fermented Foods & Probiotics – [25:56–29:08]
• Gut/Brain Connection & Disease – [29:58–34:40]
• Gut-Related Red Flags – [35:34–37:50]
• Inflammation, Leaky Gut, Wellness Trends – [38:19–41:45]
• Ask A Doctor Column: Surprising Q’s & Trends — [42:09–44:58]
• Fact or Fiction (Rapid Fire Gut Myths) — [45:23–54:56]

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Final Takeaways

• Most Americans overlook fiber and should make small, practical diet adjustments (e.g., Meatless Mondays, more fiber).
• Colonoscopies prevent (not just detect) cancer and should remain the gold standard if accessible.
• At-home screening is valuable but not a direct substitute for colonoscopy.
• Modern "wellness" fears (e.g., “leaky gut,” inflammation) are often overblown; true gut health focuses on basics: diverse, fiber-rich diet, fermenteds, and evidence-driven medical care.
• The gut-brain connection is both ancient wisdom and modern science, impacting not just digestion but mental and neurological health.

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Find More:

• Dr. Trisha Pasricha: Instagram, TikTok, Ask a Doctor (Washington Post column)
• Chelsea Clinton: That Can’t Be True podcast archive

Note: This summary excludes advertisements, introductions, and production credits.

Transcript

[Dr. Tricia Pasricha]

Lemonade.

[Chelsea Clinton]

Welcome to that can't be True, a show that sorts fact from fiction, especially on issues impacting our health. I'm Chelsea Clinton. Between the sugar highs, the detox teas, and endless tiktoks about leaky gut, it's just getting harder and harder to know what's actually true about gut health and, well, what's just not. My guest today is someone who can help us sort it all out. Dr. Tricia Pasrica is a gastrointerologist and scientist at Harvard Medical School, a longtime medical journalist, and the Washington Post's ask a doctor columnist, where she answers readers most googled, and sometimes just most personal health questions. She also has a new book coming out next spring called you've been pooping all wrong. Have we? Well, I'm sure it's going to be incredibly informative and no doubt pretty hilarious, as she certainly is. We'll talk about everything from at home colon cancer screening to why cancer is presenting earlier and more often for young people. How our guts and brains are connected, how even they communicate, and what's fact versus fiction when it comes to inflammation, fiber, and so much more. Tricia, thank you so much for being here.

[Dr. Tricia Pasricha]

I'm really grateful to be here. Thanks for inviting me.

[Chelsea Clinton]

Um, well, as I just mentioned, I'm a fan of your column. It's appropriately called ask a Doctor. And I'm just curious, like, did you start this column because you were already answering so many questions in your daily life and then you thought, well, I might as well codify this? Like, what really took you from being not only a doctor but also a columnist?

[Dr. Tricia Pasricha]

Yeah. The catalyst for me was the COVID 19 pandemic. So I had been trained as a journalist prior to that. I used to work at CNN before I went to medical school. I worked for ABC News, but then I went to medical school, got totally caught up in residency and internal medicine training, and wasn't sure if I'd revisit that until COVID 19. And I think that was, for me, the first time that it really kind of threw in stark relief how desperately we needed accurate information about health in ways that reached the public outside of the clinic. So this column was one where I joined, formally joined, as a columnist in 2023 after having seen this been building for years and years, that people were moving away, further and further away from getting their health information from a doctor that they see in person. They were getting it more and more online and online. There were often these areas where misinformation was breeding and thriving. And I don't need to tell you that. I don't need to really tell anyone here that. And we try to answer questions that are on people's minds and answer the questions that everyone can learn from who reads the column.

[Chelsea Clinton]

So, Tricia, I have to confess, what wasn't really on my mind until I was preparing for this conversation is how we poop. I have to say, like, I hadn't really thought about that. And since I was potty training my children. And you have a book coming out next year called you've been pooping all wrong. Are we pooping all Wrong? Like, what should we know?

[Dr. Tricia Pasricha]

Well, thank you for asking about it. And also how wonderful that this has not been on your mind, because it's on at least 40% of Americans minds every single day. Their daily lives are disrupted by pooping. So that's what kind of prompted me to write this book. So I'm a gastroenterologist by training. I grew up as the daughter of another gastroenterologist. So in my childhood, talking about bowel movements was like a totally normal, totally appropriate dinnertime conversation. No stigma.

[Chelsea Clinton]

Like, how you feeling about number two today? I mean, I'm just so curious what that was said.

[Dr. Tricia Pasricha]

Okay. You know, like, a lot of kids would come home and their dad would be like, well, how was school today? I would get that question, but I'd also get like, well, did you have a bowel movement today? And we'd have all these great conversations about what causes bowel movements. Like, why does spicy food make me go to the bathroom? Like, how does your body know the difference between solid liquid and gas? And when it's safe to release or not. Like, all of these silly questions I grew up talking about with my dad. It wasn't until I became a gastroenterologist myself, showed up in clinic, that I realized these conversations are, like, not what everyone else was doing when they were growing up.

[Chelsea Clinton]

You're like, my friends weren't having these conversations, too. Did you go over to people's houses when you were a kid, Trisha? And you'd be like, sitting around the dinner table and your friends might be talking about a book they read or, like, a game they'd played in. And you're like, well, is it the poop time? Like, when do we talk about poop?

[Dr. Tricia Pasricha]

Well, you know, I do think that's a sign of, like, a real friendship is, like, when you've checked in with everybody and you know, who's a regular, you feel comfortable going at their house. But it really was when I became A gastroenterologist, I started to notice people. The most common question was simply like, is my poop normal? And I was like, how do you not know if this is normal or not? You know? But people don't have it under control, right? Like, we people's daily lives are disrupted by it. COVID 19 caused this huge surge in Irritable Bowel Syndrome. One in three can't poop when they're on vacation. Lots of different problems. So I wrote this book to basically try to give people a toolkit to make it so that their bowel movements are once again the last thing they're thinking about.

[Chelsea Clinton]

And so what are the questions people should be asking themselves?

[Dr. Tricia Pasricha]

Some of the main questions is one like, am I able to have a comfortable, regular bowel movement? Right. And is it something that stresses me a lot in order to achieve, do I strain? Do I spend a lot of time in the bathroom? And what is a lot of time in the bathroom? Is also a good question. Right. As a gastroenterologist, we like people to spend less than five minutes in the bathroom. And now there's a good number of the listeners who are like, oh, yeah, no problem. I spend less than five minutes. There's a good number of listeners right now. I know this because they come to my clinic who are like, wait a minute, I spent like 15 minutes. And I think that's normal. Like, okay, that's like, it's not normal. Right. But we need to talk about what is normal and what's not.

[Chelsea Clinton]

Totally.

[Dr. Tricia Pasricha]

If you're spending a large amount of time or it's even just something that's on your mind, like, if you haven't had your bowel movement in the morning, you feel weighed down and you're thinking about it, you're stressing about it, or you're saying, I don't want to go to this party. I don't want to hang out with my friend because I'm worried about the bathroom situation when I get there. Or you're like, I eat this food, and, like, I can't pin down what it is. But every time I eat, I feel ill. And I like living in this miserable way, cutting down different things, trying out different diets. None of it's working. Maybe that's something that we can fix, too. So if you don't feel that you have a healthy relationship with your gut, even if you don't have a medical diagnosis, that's a time to check in and talk to somebody and to feel.

[Chelsea Clinton]

Comfortable and confident in doing so.

[Dr. Tricia Pasricha]

That's Absolutely right. I mean, half of what I do is trying to destigmatize, talking about our bowel movements, talking about poop.

[Chelsea Clinton]

I mean, we started off with poop.

[Dr. Tricia Pasricha]

I mean, Tricia, I love that.

[Chelsea Clinton]

That's where we've begun.

[Dr. Tricia Pasricha]

I love that. And aren't you. Yeah. Aren't you glad you invited me on this podcast?

[Chelsea Clinton]

100%. Well. And now I want to turn to, you know, talk about screening for colon cancer, which, of course is connected to the conversation.

[Dr. Tricia Pasricha]

Absolutely.

[Chelsea Clinton]

And I thought to kick off our conversation, I would play something from Saturday Night Live. Kind of one of the fake ads they do about Cologuard. In the clip, Woody Harrelson opens his front door and finds a box on his front stoop. And then this is what happens.

[Dr. Tricia Pasricha]

Hello, can I help you? Hi, I'm Cologuard. A non invasive way to screen for colon cancer at home. Oh, yeah, my doctor ordered you? That's right, because I'm safe, easy to use, and I find 92% of colon cancers. Okay, cool. How's it work? I just need to collect a sample. So open me up and, you know, go inside me. Inside you? Yeah, just go inside me. It's okay. I like it. Why is the UPS guy watching? He's just waiting to collect a sample after you're done. Yeah. So go ahead, unleash.

[Chelsea Clinton]

So clearly, you know, a lot of people are giggling. You're giggling, I'm giggling. But underneath that skid is something really important that has become more common, which is that more people are screening themselves at home. It certainly seems to be a way to make the process easier and more accessible, particularly for people for whom it might be incredibly challenging to take time off work to prepare for a colonoscopy, to actually get a colonoscopy. But there are other people who just say, no, this is a terrible idea. This shouldn't be the standard of care. This doesn't work. So what are your thoughts about at home screening?

[Dr. Tricia Pasricha]

I think the most important thing that people don't understand about the stool kits is that stool kits are incredibly good at detecting colon cancer. But that's not what I want out of a test. I want something more, which is to be able to prevent and detect colorectal cancer. And that is what a colonoscopy does. And that's why gastroenterologists like me always say colonoscopies are the gold standard. If you are able to get one, get the colonoscopy. The colonoscopy is what I would want for myself. It's What I'd want for my family members. Yes, the stool kit can detect colorectal cancer at a rate about 92%. That is pretty good, all things considered. And, you know, the colonoscopy detects cancer at about 95%. But the key thing is that colonoscopies catch polyps, which are these growths which, left unchecked, a small percentage of them will become cancer. It catches them early, and we take them right out. That's what we do during colonoscopies as a gastroenterologist, are just polypants. We're looking for polyps. We're trying to take them out. We really enjoy it. That's why we went into this field. But we take them out, and then that way the cancer never blossoms into a problem. There are certainly some people for whom the colonoscopy may not be such a great idea, and that's people who maybe are at higher risk with, say, anesthesia per se, or who really are going to have trouble getting a ride home. Then the best test is the test that gets done. So if you are absolutely not going to get the colonoscopy for any reason, by all means, get the stool kit. But just know that the reason we're talking about colonoscopy is not because it's so profound, Profoundly better at detecting cancer. It's slightly better. It is because it prevents cancer.

[Chelsea Clinton]

Trisha, I love the image that just came into my brain, admittedly, of you as a detective.

[Dr. Tricia Pasricha]

You're like.

[Chelsea Clinton]

You're like, this is why I went into this field, because I really like hunting for polyps and preventing cancer.

[Dr. Tricia Pasricha]

Yeah, I wish you could tell my parents that, like, back when I was a kid, and they're like, why do you love video games so much? Well, hey, there's this field out there, kids, where it really pays off to get good at video games, and that is gastroenterology. You could be a doctor.

[Chelsea Clinton]

I was thinking, when you were talking about, like, not eating before a colonoscopy. I recently had a colonoscopy and was very grateful to get a clean bill of health. Literally.

[Dr. Tricia Pasricha]

Wonderful. Thank you.

[Chelsea Clinton]

And also afterward, the doctor was showing me pictures of my colon, and I was like, it just looks like a pink squishy tube. Like, I don't. You're telling me. It's beautiful in the eye of the beholder. Thank you so much. We. We know that while, yes, more people are testing at home, that many people thankfully show up on schedule for their colonoscopies, provided it is kind of easy for them to Do. So they have insurance coverage, they have the ability to kind of prep safely. They have the ability to get a ride there and a ride home. That unfortunately, cancer rates are really on the rise for people my age, for people kind of under 50. We certainly see it with colorectal cancer. We see it though in other cancers too. Prostate, uterine, breast. What do you think describes the rise, especially in colorectal cancer?

[Dr. Tricia Pasricha]

It's a really common. I probably get at least a handful of this exact question every week in my inbox. Oh, wow. So it's on everyone's mind. And it is true that the rates of early onset cancer, not just colorectal cancer, but breast cancer, uterine cancer, lots of different cancers, have been on the rise since at least the 1990s. And in the past, we used to think of the major risk factors for cancers being genetics and smoking. And over the last couple of decades, our genetics haven't changed too much and we're actually smoking less, which is a wonderful thing as a country and as a world. So we've come to the conclusion that it has to be something in our environment, has to be something about our lifestyles. And there are three big categories for which there have been major epidemiological studies that really support what those categories could be. And there are three things that we actually haven't really framed until more recently as cancer risk factors. So one of them that I always tell people about, these three, the first is alcohol. Okay, Alcohol use. We are fighting against decades of dogma that says a glass of wine a day, a couple glasses of wine is actually good for your heart, it's good for you. Well, data has accumulated over the last several decades. It was the major focus of the former US Surgeon General's advisory that there is no amount of alcohol that is safe for you when we're talking about cancer. Okay, you can drink those glass of wine a day thinking that you're actually helping your heart risk, but you are not improving your mortality and you're actually increasing your cancer risk. And the same kind of data has also emerged for dementia. There's no safe amount when we're talking about dementia risk. So we have to fight against that dogma. Alcohol is one of them. What we're eating, okay, that's a huge one. Especially when we're talking about colorectal cancer and within what we're eating. This is going to shock nobody. But ultra processed foods is a big part of it. And kind of the other side of that coin is not replacing our meals, our ultra processed meals. With more high fiber kinds of foods. High fiber food is very protective against colorectal cancer. Answer.

[Chelsea Clinton]

And Tricia, like, just if people don't maybe know what you're talking about. High fiber foods include people might think like an apple, but what else is a high fiber food?

[Dr. Tricia Pasricha]

You know? Yeah. So fruits and vegetables in general all tend to have good amounts of fiber. When we're talking about goals, sometimes we think about, well, what are the kind of grams of fiber I need a day? And you can calculate that for women under 50, you want to be shooting for 25 grams of fiber a day or more. And men, it's actually a lot more. It's 38 grams of fiber a day. And when you do the math and you look, okay, what have I eaten a day? More than 95% of Americans are not meeting those goals. And oh, wow. I know, I know. We have a lot of work to do.

[Chelsea Clinton]

That whole an apple a day right.

[Dr. Tricia Pasricha]

Adage. Yep. It gets you in the right direction.

[Chelsea Clinton]

Gets you in the right direction.

[Dr. Tricia Pasricha]

It's probably not going to help you get there. And so we're talking about whole grain foods, right? So it's not that, you know, highly processed, refined white bread that's shelf stable. We're talking about whole grain breads, whole grain pastas. Those are fine. We're not saying cut out carbohydrates, but we are saying make the center of your meal, the vegetable, the leafy, fibrous green, maybe not the carbohydrate. You can get there. You can get up to 25 grams for women, 38 for men. But if you don't, something I tell people that's relatively simple is just take a fiber supplement, start there. Changing your whole diet is really hard. Add a fiber supplement every day. And specifically, psyllium is a type of fiber that's been well studied and can improve your risk. The other areas in your diet that can help you with your colorectal cancer risk are red meat. Okay. Red meat is kind of emotionally charged because it's such a part of our cultural diet. Red meat's a big part of our summer holidays. It can be hard to hear that data that this is associated with cancer. So when I see somebody and I've done their colonoscopy and they have three or four polyps, I usually don't, when they wake up, be like, congrats, you're vegan from now on. Nobody would stick with it if I did that. But what I often say is, why don't we try something simple and small like let's try Meatless Mondays, see how that goes for a couple weeks. Or there are ways that you can cook your meats that are probably a little bit safer. Like, for example, marinating your meat has been shown to reduce the carcinogens by 88%. So that's a small, simple step you can take.

[Chelsea Clinton]

I didn't know that.

[Dr. Tricia Pasricha]

Well, there you go. I usually tell people, make small steps. And then the third thing within our diet that's been really strongly linked to cancer and specifically early onset colorectal cancer, are these sugar sweetened beverages. And if we drink more of those in our childhoods, which statistically we have been doing that more and more as a country since the 1980s, 1990s, that is linked to early onset colorectal cancer. Getting cancer when you're in your 20s, when you're in your 30s. So cutting those down can also be really helpful.

[Chelsea Clinton]

Tricia, though, I think an important, not coda so much as maybe a continuation of this conversation is I also think, though there's data that if people do make changes, their relative risk decreases. So I think that's an important part of this conversation too. So people aren't listening, are like, oh my gosh, I drank all these sodas as a kid and there's nothing I can do. Or oh my gosh, like, I lived on a diet of red meat and, I don't know, tequila or something in their 20s.

[Dr. Tricia Pasricha]

Right.

[Chelsea Clinton]

People can make different choices on any day that really can help shift their risk profile.

[Dr. Tricia Pasricha]

That's a really important point. And I will say, I think the, maybe the even biggest point of all of this is to say that there should be no sense of self blame when we're talking about cancer risk. Right. A lot of these younger people who get cancer, it can be so easy as an outside person to be like, well, I wonder. Exactly. I wonder if they drink a lot of sugary sweetened beverages. Did they eat hot dogs every day? That's not one of them. That's not helpful. Two, A lot of these risk factors occurred during our childhood. They happen to our environments. They can even. There are risk factors linked to our mother's pregnancy. These aren't things that we were making conscious choices about ourselves. It's not healthy helpful to have those conversations. And there's so much that goes into it that's individualized. But to your point, I think you're absolutely right that there's. We shouldn't feel like, well, let's just give up now because, like, you know, I'm in my 30s. I've, like, done some wrong when I was in my college years, like we all have. But you are right that every day that you make a healthy choice is a healthy choice for you, for your longevity, for your family members. And one point I remember, you know, like, just to speak about why doing the screening, making these choices is so helpful, I wrote this story for the New York times back in 2023 that was about how to prep for your colonoscopy. And I was giving people my best tips for how to make. Because people have this idea that colonoscopies are horrible, that prep is so painful. And it's this big procedure. It's actually a 30 minute procedure, maximum. It's much easier than what your grandfather had to go through. Thank goodness. So I was telling people what those tips were, and in the comments, there was one person who wrote this comment that has just stuck with me. It's really haunted since because the comments were filled with a lot of people saying, I had this great experience with my clonals. It was much better than I thought. And a lot of people who are like, this prep sounds bad. I'm never gonna do this, or the anesthesia is not worth the risk. All of these things. And somebody wrote in and they said every single one of these excuses in this comment thread. My father made every single one. And he died of colon cancer too young and he's missed every single day. Don't do this to your family. Just get the screening. And of all the comments, this is the one that I think a month doesn't go by that I don't think about it. Because when we're talking about all these decisions to get screened to make these lifestyle changes, it's not always about you. I think about all the people in your life who are really depending on you, who are going to be hurt if you don't do the screening, if you don't make the changes. And sometimes when you think about it in the big picture, half people, I will say, who come to get colonoscopies, they're like, I'm only here because my husband or my wife dragged me here. I'm like, wonderful. The best wife ever. Yeah, like, she, like, kudos to her. She's awesome. But they're coming in because they love somebody and somebody loves them. And that's really important. If not for yourself.

[Julia Louis-Dreyfus]

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[Chelsea Clinton]

You mentioned sugar sweetened beverages as being a risk factor, you know, later in life if consumed at big quantities in childhood. You know, for any parents listening and including me, what other advice would you have for us as we look to lower our kids lifetime risk of colorectal cancer?

[Dr. Tricia Pasricha]

It's a really good question. And so I have a two year old and a three year old and I'm thinking about this all the time. I sometimes joke, although it's not a joke, it's like who I am. I like micromanage their microbiomes like all the time. And I think about a couple of different things. One, I think how we set their palates early on in life can really set them up for success later on. Now we can change at any point, but our microbiomes are the most malleable in those first few years of life. And so whatever I can do to support them in those stages when they are going to be more sort of susceptible to the good and the bad things that we put into their diets, I try to maximize. So what that means is simple things. Okay, I try to just center the vegetable. I make that the center of the meal and then the protein and then the carbohydrates. So as opposed to saying like you're going to eat this whole bowl of Mac and cheese, like that's the whole dinner is the Mac and cheese that's part of it. We all love Mac and cheese, but that's going to be a quarter of it. And we're going to find the vegetables that you like and we're going to find some protein. Maybe it's meat, maybe it's not. That's gonna help you feel full and help nourish you. My kids are just like everybody else, right? Like, they, like, they enjoy these pouches that are like, you know, sugar sweetened that are, they're a big part of like a toddler's experience in America. But we don't, we don't, we try to not reach for those regularly. We don't, we don't bring them into the house.

[Chelsea Clinton]

And Tricia, I think importantly, you know, for people who may live in a place where it's hard to get fresh fruits and vegetables or who may not be able to afford fresh fruits and vegetables, frozen fruits and frozen vegetables also have real health benefits.

[Dr. Tricia Pasricha]

100%. We eat frozen food all the time. Like, I mean, I think it's. Frozen fruits and vegetables have like an exactly comparable nutritional value and they're very helpful. And it's hard to like go shopping for fresh fruits and vegetables. I'm all in on whatever it will take to get you to eat healthy amounts of not just increased fruits and vegetables. I want you to meet those, those fiber goals. But really what I want, if we're going to take it to the second, the next step is for you to eat a diversity plants. So not just broccoli every single day, which is the thing that my family really gets into, but like, the more, the greater number of different vegetables, different fruits, different types of legumes, seeds, like these things, you can introduce your diet that will reflect in your microbiome. Your microbiome will become more diverse and that's linked to numerous health outcomes.

[Chelsea Clinton]

So, Tricia, you've mentioned microbiome a few times. Maybe you can define what you mean by kind of microbiome and is it the same as like when we talk about gut or do you think those are different terms?

[Dr. Tricia Pasricha]

So the microbiome has been one of the hottest areas of research in the last several decades. And I think the best comparison I can make for what the microbiome is is that it is like this garden that is inside our gut. Most of the microbiome are all of the microbes, the trillions of microbes that live in our gut.

[Chelsea Clinton]

Trillions? Trillions.

[Dr. Tricia Pasricha]

Oh, yeah, you heard it. We are vastly outnumbered by our bacteria and they live there usually in a happy relationship with the rest of our bodies and then all of their genomic material. We call that together the microbiome. It's kind of taken on a life of its own, though, in how people on social media often I see this, certainly there's a big probiotic industry. People are trying to harness their microbiome, sometimes in ways that get increasingly further away from the science of the microbiome. So, and a good example is that I think that we have learned that the microbiome has a really important role in lots of different aspects of our health, not just gut health. Our microbiome disturbances to this are linked to cardiovascular disease, to dementia, to Parkinson's disease, which is something I study in my lab. But it's, in a way, despite the fact that we've known about the microbiome for decades, we've been studying it really hard, modulating the microbiome and tailoring that therapy to the individual is really in its infancy. And so blanketly saying, here's a probiotic just in a pill and that's going to fix some problem. Bloating, brain fog, stomach ache after eating, we're missing several steps in between that could be going on. So are we eating this diversity of fruits, of vegetables that we like to see? Are you meeting your fiber goals? I keep coming back to fiber. I'm going to keep boring you with that.

[Chelsea Clinton]

No, it's okay.

[Dr. Tricia Pasricha]

And then three, what about fermented foods? Like, we need to have a conversation about fermented foods.

[Chelsea Clinton]

Talk to me about fermented foods.

[Dr. Tricia Pasricha]

Like, how many of us are introducing fermented foods and tried, but our microbiomes love a good fermented food.

[Chelsea Clinton]

Like pickles.

[Dr. Tricia Pasricha]

Yes.

[Chelsea Clinton]

Oh, we love pickles in my family.

[Dr. Tricia Pasricha]

So we should, we should get the kids together. We love a pickle. I recognize I didn't grow up liking pickles. A lot of people are like, oh, I don't wanna have pickles. I don't have sauerkraut. I'm not sure about kimchi.

[Chelsea Clinton]

Like, these are, oh, I love sauerkraut.

[Dr. Tricia Pasricha]

I love a good kimchi and I love someone who loves sauerkraut. If they are not into that. There are other fermented foods, like Greek yogurt, for example. Actually sourdough bread.

[Chelsea Clinton]

Love Greek yogurt.

[Dr. Tricia Pasricha]

Hello.

[Chelsea Clinton]

I'm feeling very good about myself right now. Love apples, love high fiber foods, love Greek yogurt. Like pickles.

[Dr. Tricia Pasricha]

You're doing it all right. In Indian cuisine, we have this thing called a dosa. If you've ever tried that, love a dosa. Thank you. First of all. Thank you.

[Chelsea Clinton]

Had a dosa and eggs yesterday morning for breakfast, actually.

[Dr. Tricia Pasricha]

Impressive. You made it yourself?

[Chelsea Clinton]

No, my friend made it.

[Dr. Tricia Pasricha]

But, you know, but amazing. Okay, so that friend has a good microbiome.

[Chelsea Clinton]

Homemade. But not by me. Not by me.

[Dr. Tricia Pasricha]

So there are other ways right? Beside like that are not pickles, if that's not your thing that you can introduce. And there was this like, very nice study that came out of Stanford University that looked at people who were randomized to a high fiber diet for 10 weeks. People who were specifically told you have to have fermented foods every day. And actually the people after 10 weeks who had fermented foods, they had more microbial diversity than the people who are just eating a high fiber food. And this is a big study. It came out in cell and it really shows that if you want to go like, my first step is high fiber. That's a hard stop. If we can get there, if we can take you out of that 95% into the 5%, I will feel that we've won. But I really like to tell those people who are into maximizing their gut health that let's not sleep on the fermented foods. We know in these big studies that it makes a big difference.

[Chelsea Clinton]

Trisha, I feel like another conversation I often hear kind of swirling about when people are discussing kind of the microbiome and kind of good gut bacteria at times is a caution around antibiotics, right? Like don't take antibiotics because they're going to kill all your good bacteria. What are your thoughts on that?

[Dr. Tricia Pasricha]

Antibiotics have been villainized a little bit inappropriately in this situation. Nobody should take antibiotics that are not medically indicated. This is a big problem, especially in our pediatric population where we often are a little bit loose to give out antibiotics when we don't know that we're talking about a bacterial infection and we're just actually treating a virus which is not going to be treated at all. Antibiotics, we can all agree that's something we need to do less of, but if it's medically appropriate to take the antibiotics, you should take it. And you should also know that, yes, antibiotics often do cause a transient disturbance in your microbiome, but this has been shown in studies. Your microbiome is incredibly resilient. It will bounce back within about three weeks. Oh, wow, that's quick.

[Chelsea Clinton]

That's super quick.

[Dr. Tricia Pasricha]

Super quick. And it's also, you know, I will say it's also why it's sort of hard to change your microbiome as an adult once you're an adult, your microbiome becomes a little bit sticky and it's harder to treat. You really have to overhaul your diet and stick with the diet, dietary change for months before you're going to see that change. There aren't these quick fixes and even antibiotics, we are resilient enough that your microbiome will, will bounce back there. There are some data that is stronger in childhood for taking a probiotic. At the same time, the data is so weak and so mixed for adults that it's actually not something that the, that most gastroenterologists recommend. It's not recommended by the American Gastroenterological association, which is our big medical society. And it's simply because we don't need it because we know anything. Your microbiome is going to come right back.

[Chelsea Clinton]

You know, you referenced earlier how connected our microbiome is to our brain health, our heart health. You mentioned kind of your work on studying Parkinson's. I wonder what else either from your work or work you're familiar with, kind of related to the microbiome also has kind of clear implications for either our whole health in ways we haven't talked about yet or, or other parts of our body.

[Dr. Tricia Pasricha]

Yeah, I love this question. So I study the gut brain connection and I think the side of that conversation people are often very familiar with is how our brains influence our gut. Like we often talk about, we know this when you're stressed, it can wreak havoc on your bowels, right? Like why do we, all, right before our turn at karaoke, have to go to the bathroom? It's because that acute stress or kids taking tests, right?

[Chelsea Clinton]

They're like, oh, my stomach hurts totally.

[Dr. Tricia Pasricha]

And they're not lying, they're not making up some excuse. It is very real. And we've known about that connection since at least the end of the 19th century. We've been studying it and that with.

[Chelsea Clinton]

That and that's really interesting, right. I think a lot of people think, you know, particularly some of the folks in the so called like wellness area who are like, you know, medicine has neglected this. And Tricia, you're saying no, actually for, you know, at least like 125 years, medicine has been studying this.

[Dr. Tricia Pasricha]

We've been fascinated by it. I mean, let's go back to Pavlov's dogs. You remember Ivan Pavlov. So he was studying conditioned reflexes. So the way that the story goes is that he had this pack of dogs and he would ring a bell and apparently it's not really a bell. Like we Just we want to believe it was a bell, but with maybe some other instrument. Isn't that great? I know it's like, a little disappointing, but apparently it might not have been a bell.

[Chelsea Clinton]

Isn't that what I learned in biology at Stanford?

[Dr. Tricia Pasricha]

I know, devastating something that he was using some sound maker.

[Chelsea Clinton]

Professor Fernald, that wasn't accurate.

[Dr. Tricia Pasricha]

Write him an email after this. But he. So he rang this bell every time he brought food in for the dogs. And when he rang the bell, the dogs would start to salivate and they'd be like. Eventually they would start to realize every time they heard the bell, dinner was on its way, and they would start salivating. Even when all he did was rang the bell and no dinner was brought in. And that was called this conditioned reflex. But if you look at this from the lens of gastroenterology, or neurogastroenterology, which is what I am. What this is really telling us is that the first step of digestion begins in the brain. It's called the cephalic phase of digestion. And it just shows how powerful our thoughts are in creating real physiological changes in our guts. Now, we've been. So we've been thinking about this for a long time, like, since the time of Pavlov. It is only more recently that we are beginning to discover the incredible ways that the gut influences the brain. So 90% of the signaling between the gut and the brain through the vagus nerve is from the gut upwards, not the other way around.

[Chelsea Clinton]

Oh, wow.

[Dr. Tricia Pasricha]

And if you think about it, I mean, this is how the whole hypothesis of. It's called Brock's hypothesis, that Parkinson's disease can originate in the gut. That's what I study in my lab. We think of Parkinson's disease as this disease of the brain. But what if in a subset of people, it started in the gut? And you'll actually find if you talk to Parkinson's patients, that 80% of them start to have GI problems, gut health problems, years, decades before they get tremors, before they have trouble walking. And we think it's because the enteric nervous system, which is the nervous system in the gut, is starting to show signs of the disease before it propagates up the vagus nerve to the brain. So that's one area that is very exciting that we think a lot about. But it's more than that, too. Like, we know that ulcers, damage to the gut, can literally cause anxiety and depression. We've proven this in mice. We've seen it play out epidemiologically in Humans. So there are times when people come in with a lot of anxiety and depression. I see this in my. My clinic. And they also have a lot of gut trouble. They might have irritable bowel syndrome. They might have stomach pain that no one can explain. They will get told often that this is all in their heads and take an antidepressant. What you need is to de. Stress. You're too stressed. And certainly if you are living with chronic pain and chronic GI symptoms, you're going to have a lot of mental health problems. That's true for any chronic disease, not just GI diseases. But the treatment needs to happen at the gut, and we neglect that other side of it. And this is also like a big part of advocacy that my group at the Institute of Gut Brain Research says. But it's really making people aware that a lot of it's what Hippocrates had said from the beginning, that he said all disease originates in the gut. I think it's many diseases originating in the gut that we don't even classically think of as a gut health problem.

[Chelsea Clinton]

So not just 125 years, but thousands of years kind of people who've studied medicine have understood there's a gut brain connection, even if they haven't understood the contours or the mechanisms of that connection. You know, Tricia, I just. I was so struck when you were sharing that, you know, when you speak to Parkinson's patients or when other people who kind of are in your field of research do, you know, 80% can remember, you know, having discomfort or tremors kind of in their. Their gut before, kind of discomfort and tremors across their whole body. For anyone listening, what are the gut symptoms that you would want people to just be really finely attuned to, whether it's an early sign of Parkinson's or colorectal cancer, both of which we've touched on and other kind of things that maybe we haven't talked about yet.

[Dr. Tricia Pasricha]

Yeah, thank you for asking this. So let me tell you the big ones. So. So any kind of rectal bleeding, you should talk to your doctor sooner rather than later. Rectal bleeding can be a lot of things we don't have to overly worry about, like hemorrhoids, for example, but they're one of the most important signs of early onset colorectal cancer. And in addition to rectal bleeding, abdominal pain, new diarrhea, and certainly if you reach the point that someone's telling you you have iron deficiency anemia, those four things that any of those, you should seek attention and Say, wait a minute, have we just. Have we made sure that there's not a colorectal cancer here? And the reason I say that is that sometimes younger people, they're a little bit more reluctant to get care. And unfortunately, sometimes doctors are a little bit unable to say, okay, we should be thinking about cancer because you're so young. Younger people, there's often a delay, studies have shown of about two months before they get appropriate care for cancer because of both of these things. So those are the big red flags when we're talk about cancer. Any new GI symptom, I'm going to take a step back. Any new GI symptom that's bothering you, you should talk to your doctor about, especially when it's new, like so new constipation if you're an older person, new diarrhea, new changes in what your poop looks like, talk to a doctor and make sure we're not missing something. One thing I tell people, especially women, is that bloating, it's really common. A lot of women have been living with this their whole lives. It's more common in women than in men, although men certainly get this. But if you are postmenopausal and you're a woman, you've never had bloating in your life and suddenly you wake up and you feel bloated, don't wait on that. Tell your doctor about that immediately. And the reason for that is that sometimes that's the only sign of ovarian cancer is new bloating in a post menopausal woman. And then we sort of brush it off, right? Like we say, oh, it's something I'm eating, I'm just a woman. Like we all live with bloating. You know, ovarian cancer is not the most common reason why we get bloated, but it is a no miss kind of sign that if somebody comes to my clinic and that's the description that they're giving me, I always rule it out because ovarian cancer is sometimes thought of as a silent killer because it's very easy to miss.

[Chelsea Clinton]

One of my sisters in law tragically died of ovarian cancer. So certainly I hope anyone who might be experiencing the symptoms who are postmenopausal will listen to, listen to what you just said and remember it not only for tomorrow, but for the long while hereafter. I do want to talk about something else that I hear a lot about these days. Well, to be fair, I feel like maybe for many days, but particularly in recent months, which Is inflammation?

[Dr. Tricia Pasricha]

Yes.

[Chelsea Clinton]

Chronic inflammation, specific gut inflammation. This really feels so, I think pertinent because as Health and Human Services Secretary Robert F. Kennedy Jr. Says that he can see inflammation on a kid's face when he walks by them. What reflections do you have about inflammation? Kind of what does the science tell you? How does this relate to the conversation we were just having about the microbiome and how does it maybe not connect at all?

[Dr. Tricia Pasricha]

Yeah, inflammation is our body's natural response to some kind of trigger. And that trigger might be an infection, it might be a wound. And that inflammation in those cases are actually quite good for us. We need that inflammatory response, which means we are bringing in our immune cells and our repair mechanisms to either fight that infection off or to heal that wound and lay down the framework to do that. There is a situation that can happen where we get chronic inflammation. The most kind of the big examples of that are in people who have big infections that you would know about because you would have big symptoms about that. You'd see a doctor, you'd go to the emergency room. Or autoimmune conditions. Autoimmune conditions like inflammatory bowel disease, rheumatoid arthritis, that's when your body is attacking itself with its own immune system. These people in these categories are going to have high levels of inflammatory markers in their blood. We're going to be able to see that and measure that objectively. That's not what people, I think are talking about when they say, I'm living with inflammation. Right. Like they're talking about the kinds of low level inflammation that may not surface in some of these classic markers in the long term, but nonetheless sort of exist now. Now there are a number of diseases that seem to be linked with that kind of inflammation. That's Alzheimer's disease, for example, like dementia, cardiovascular disease. But it's sort of like a lot of other things we've talked about today in which inflammation in and of itself is more of a symptom than it is the root cause. And it's not going to be measurable, really in a validated clinical way outside of those big disease states, like an autoimmune disease. So I think this conversation that I often happening on social media about inflammation is like, started in the right direction and is like now slowly, like missing the mark and trying to target something. And then, you know, certainly companies are jumping in to try to sell you tests that will tell you how, you know, how inflamed you are. And those tests are not validated. They're not going to help kind of an average, maybe otherwise healthy person.

[Chelsea Clinton]

And Tricia, when people say, you know, I was in Europe and I ate a lot of pasta and bread and I didn't feel like I had inflammation or I didn't feel like I was bloated, what do you think that is about?

[Dr. Tricia Pasricha]

That is one of a gastroenterologist's greatest life mysteries. So gluten sensitivity, I know is real. We have that data, why people are able to eat bread in Europe. There's actually a number of hypotheses, none of which I buy. Some of it is like, okay, it's the food supply issue. It's like, and this part's true. A lot of the bread we eat here that is shelf stable is ultra processed. Sure. But a lot of people also can't eat like the really fresh baked bread here either. Or is it the pesticides? Are the pesticides different? Is the kind of wheat different? We're never really going to be able to prove that. Well, but these are some of the theories that float, float around online.

[Chelsea Clinton]

And this is why research is so critical.

[Dr. Tricia Pasricha]

Yes.

[Chelsea Clinton]

You know, just in our last few minutes, I first want to ask you about your column at the Washington Post. Ask a Doctor. And I'm really just curious, both kind of what the most common question you get asked is and if that's shifted, you know, kind of this year versus maybe prior years. And maybe what's the wildest or most perplexing question that you've gotten?

[Dr. Tricia Pasricha]

I'll take the first one for the last one first, which is that sometimes the wildest questions I get are trends on social media that I haven't even caught yet.

[Chelsea Clinton]

Like, they'll ask me, like what? Like what?

[Dr. Tricia Pasricha]

Like recently I got a really good one about mushroom coffee. I don't know if this is a thing that you drink or you know about. Wasn't on my radar.

[Chelsea Clinton]

I do know about mushroom coffee. I have to confess, I have not tried mushroom coffee.

[Dr. Tricia Pasricha]

I can't tell you. I think you should, like, look to do it. But sometimes I get these kind of interesting social media questions and then I get to dig into the data and answer them. So some of those are exciting to me. But I will say the most common one, and I bet this will, I don't know, might surprise people, is I get these long, long letters that are just highly specific personal medical questions about their own situation that I, like, tragically cannot answer because I'm not their doctor and I don't have the whole picture. But that's like half of the Questions I get are like, really, really specific.

[Chelsea Clinton]

What a remarkable reflection of the confidence that people have in you.

[Dr. Tricia Pasricha]

That's one way to look at it. So I appreciate that. But the way I look at it is actually a little bit bleaker, which.

[Chelsea Clinton]

Is that they don't have a primary care doctor.

[Dr. Tricia Pasricha]

Yeah. I think this reflects the fact that our whole system is nobody is getting in to see their doctor. We don't have enough primary care doctors. Like, these 15 minute visits are insufficient. They're totally insufficient. You're like, do I need a colonoscopy or not? You're not going to ask them, like, is creatine powder good? Or, you know. But it's like really specific questions. And so it makes me kind of sad when I see these because it just tells me that people don't have a doctor that they feel they can trust, that they have a good relationship with it. I mean, this comes back to why we started the column. We know people are going increasingly online for their medical information. And not just that they're going online because they have to, but it's reached the point that especially among Gen Z, people more and more trust what they see online more than they will trust their doctor. And so having a somewhat trustworthy source of that information that's meeting people where they're at is really important. But it's also just, I think, the best thing. I always say this in my column. There's almost always a line at the end of it that's like everything we said run by your own doctor first. This is not really your personalized medical advice. You always should talk to someone. And I often get comments in the responses. That's like, I will never be able to get an appointment with my doctor to ask them this to save my life. And it is so heartbreaking.

[Chelsea Clinton]

Well, that's infuriating and painfully not surprising. You did, though, mention how frequently people are going online for medical information and also medical advice about. About their gut. And that's a good segue into kind of the last segment of our conversation, which is called fact or fiction. So I'll throw out some things that are currently percolating online and you'll tell us whether they're fact or fiction.

[Dr. Tricia Pasricha]

Wonderful. Okay.

[Chelsea Clinton]

Reading on the toilet is bad for you.

[Dr. Tricia Pasricha]

Ooh. We have been reading on the toilet since the dawn of time, like we have. So I. This is going to like, you know, like my lab, we study a lot of things. One of them is what we do on the toilet. So, like, this is like, near and dear to my Heart.

[Chelsea Clinton]

So like, like I'm now so curious, like what else do people do on the toilet? They like, do you study the difference between like reading on a phone versus reading a book versus like doing a crossword puzzle versus Sudoku? Like, what does that mean?

[Dr. Tricia Pasricha]

Trisha, we should recruit you to the lab. Like those are the exactly correct questions. So we know in the past there was this like very nice study in the 70s that showed that people who read the newspapers was a British study, read the newspaper, tended to spend longer on the toilet than people who didn't bring the newspaper in.

[Chelsea Clinton]

That's not terribly surprising.

[Dr. Tricia Pasricha]

Not terribly surprising. We updated that study last year in my lab and looked at does taking your smartphone to the bathroom not only increase the amount of time you're spending, but is it associated with an increased risk of hemorrhoids? The answer is a resounding yes. So my advice to people is I think reading on the toilet is not inherently a bad thing. I think it can help you relax. You kind of need to relax to have a bowel movement. If you want to just like bring back the old fashioned mentioned bathroom library, be my guest. The smartphone, which like keeps you scrolling all the time. You lose track of time. That's what I think you should keep outside the bathroom. Primarily for hemorrhoids.

[Chelsea Clinton]

You should have a bowel movement. Slash, poop every day. Fact or fiction?

[Dr. Tricia Pasricha]

Fiction. This one. Shocker. Right? Because like we've been saying since like civil War era medical manuals that you should have one a day. You should have a bowel movement as often as feels comfortable for you and at a socially appropriate time, whatever that means for you. Now there's some guardrails, which is to say if you're going more than three or four days without a bowel movement, I want to talk to you. If you're having it so often a day that it's interfering with your social life or your work, then we can talk again. But for example, it depends on your diet. It depends on other habits. In India where people have. In eastern India, there's been studies where people have a very, very high fiber, mostly plant based diet. Diet. Two or three bowel movements a day is considered normal, you know, and like in America, it's like just like one, maybe even slightly less than one is considered normal. It's just entirely dependent on you and your diet. So don't be so hung up on the number as much as how that number makes you feel and making sure that you are able to do it in a way that's not interfering with your daily life.

[Chelsea Clinton]

Not all toilets are created equal. Some are better for you than others. Fact or fiction?

[Dr. Tricia Pasricha]

This is one of my favorite topics.

[Chelsea Clinton]

I love that this is one of your favorite topics right now, Trisha, I want to know, like, what are your other favorite topics? What have we not talked about yet? I mean, do you have views on, like, toilet paper? Like, I'm like, I'm now so curious.

[Dr. Tricia Pasricha]

Oh, 100%.

[Chelsea Clinton]

Like, okay, all right, well, I'll ask about toilet paper next. But first, tell me about whether or not all toilets are as good for you as could be or. No, some are better for you than others, you know?

[Dr. Tricia Pasricha]

Okay, so I will say the dream toilets is one that has a heated seat and is a bidet. No, the heated seat is the luxury. The bidet is the necessity. Okay? And I know, like, people are not ready for this conversation in this country. Okay?

[Chelsea Clinton]

I mean, I'm like, this is the only thing that we've talked about in, like, over an hour. I'm like, really?

[Dr. Tricia Pasricha]

Stick with me, Chelsea. All right? A bidet.

[Chelsea Clinton]

I'm here. I'm not going anywhere. All right, tell me more.

[Dr. Tricia Pasricha]

Better for you if we're talking about hemorrhage. Hemorrhoids. Better for you if you have a lot of diarrhea. I recommend bidets all the time to, like, my postpartum women who are, like, you know, like, that whole area is very sensitive. Anybody who doesn't want to be constantly wiping people who are struggling with movement. Like, so my Parkinson's patients, I tell them to get a bidet because it's actually. The toileting experience can be really hard if you have balance issues, of course, you know, it's, like, difficult. But the bidet can help you with that. It's. It can not only clean things up, but it can air dry. And so you don't have to actually reach back there and struggle and fumble as much as you would if we're just using toilet paper. Now, if you want to have the toilet paper conversation. I do.

[Chelsea Clinton]

I do. Now tell me more.

[Dr. Tricia Pasricha]

All right, see, we've got one ply. We've got two ply, right? And first of all, for me, let's not do toilet paper at all. Let's go bidet. But I think one ply is for people who don't love themselves. Everybody deserves two ply. And there's absolutely no reason other than, like, saving your corporation some money by going oneply. I haven't proven this in a study yet, but I'm desperately trying to get.

[Chelsea Clinton]

My plan hopefully you will next time we talk have real data to back up the superiority of two ply 100%. Okay, okay.

[Dr. Tricia Pasricha]

This is just my expert opinion that two ply is what people who practice self care use.

[Chelsea Clinton]

It's amazing. Okay, a couple more. More. We can cure leaky gut syndrome. And I guess I'd first ask what is leaky gut syndrome? And then fact or fiction? We can cure it.

[Dr. Tricia Pasricha]

Leaky gut is so deeply misunderstood. We all have this physiological phenomena in which we have increased intestinal permeability. That means that the, the cells that line our gut, at times they open up a little bit more and things can pass through into our bodies a little more easily. And at times they close a little bit more tightly.

[Chelsea Clinton]

And is that related to anything that we do? Any choice that we make?

[Dr. Tricia Pasricha]

It is related to things that we do. We know that stress increases leaky gut, like psychological stress has been shown. They studied this actually in college students about to orally defend their thesis that will increase intestinal permeability. The stress of that NSAIDs, so like Ibuprofen, Aleve, etc. Motion, all these things that causes those tight junctions to open up a little bit. Alcohol, You've heard that before. Before Ultra processed foods. You've heard that one before. These things are not considered good for us and they can cause increased intestinal permeability. But our intestines are kind of infections can do it. Like they're kind of fluctuating at all times. I think the problem is that a lot of people have attributed these big broad symptoms that are hard to understand, hard to treat, like bloating, like brain fog too leaky gut. And to me, one, we don't have a great test for it. We have tests for it in a research setting. We don't have a good clinical test that's been validated. To me, leaky gut is like a lot of things we've talked about today, which is that it is a sign of something. It's not actually the underlying problem. You have to go a little deeper with all these things to figure out what is it that's happening to me or that I might be doing, contributing to it.

[Chelsea Clinton]

Last question, which I ask with a cup of coffee in my hand. Not all coffee is created equal. Filtered coffee is better for us or at least better for our gut than unfiltered coffee. Like French press. Fact, fiction.

[Dr. Tricia Pasricha]

Half fact.

[Chelsea Clinton]

So you're like, I choose not what you said. I'm making up my own category.

[Dr. Tricia Pasricha]

So coffee, like your gut loves coffee, right?

[Chelsea Clinton]

Like love hearing that I'm so happy that you have not mentioned coffee as, like, one of the dangers to avoid because I'm like, thinking, I'm like, oh, yeah, I have a good diet. I exercise. I don't drink a lot of alcohol. I have, like a pretty good sleep. I. I drink a lot of coffee. Definitely. Probably too much coffee. But she hasn't mentioned it yet, so maybe in this context, I'm.

[Dr. Tricia Pasricha]

Okay, well, let's talk about that so.

[Chelsea Clinton]

We can talk about it.

[Dr. Tricia Pasricha]

So moderate amounts of, of coffee, like on the 3 cup range, even 4 cup, depending on how you do it.

[Chelsea Clinton]

Yeah. Okay. Per day I do that. Yeah. Okay, great.

[Dr. Tricia Pasricha]

Okay. Amazing.

[Chelsea Clinton]

I aspire to drink less than four a day. And, you know, more often than not I reach that. And then some days I really fall off the wagon.

[Dr. Tricia Pasricha]

We all have those days.

[Chelsea Clinton]

Thank you. Thank you for that empathy.

[Dr. Tricia Pasricha]

Thank you, Trisha. So one, your gut loves coffee because it stimulates the gastrocolic reflex. It's why about a third of us who drink coffee have to go to the bathroom afterwards. That is normal. Your gut love loves it. The problem with French press comes in, unfortunately, Chelsea, when you are drinking like multiple cups a day, like the six to eight cups a day.

[Chelsea Clinton]

But what if I'm just drinking filtered coffee?

[Dr. Tricia Pasricha]

If you're just drinking filtered coffee, you're in the clear. So what a. And we're talking about paper filtered, okay? Not like a metal sieve like we see in French press. Not espresso like a traditional espresso, which is not filtered. Filtered coffee with a paper filter that is. Is eliminating this compound in the coffee called diterpenes. And these basically elevate the cholesterol in our BL blood. If studies have shown that people who drink several cups of espresso a day and. Or people who drink several cups of French press, which is unfiltered. Both of these are unfiltered coffees. They have higher levels of cholesterol. They seem to have less of a mortality benefit than the people who drink filtered coffee. By the way, this is the good news part of the story. Drinking filtered coffee is associated with a mortality benefit. You're going to live longer if you drink coffee, or at least you have an association of living longer. Longer.

[Chelsea Clinton]

Trisha, I am going to clip this and send this to my mother, because my mother is often like, you drink too much coffee. And I think importantly, too, even if you're only having a couple of espressos or French press a day, that sounds like you're not dripping into the danger area. It's if you drink a lot of.

[Dr. Tricia Pasricha]

That, I think the studies have really shown that it's in that higher amount. But I will say if you're somebody who has high baseline cholesterol, like I probably myself would move away from French press and I would like, even if I'm only drinking, only drinking like three or four or four cups a day, I probably would. But it's a conversation you should have.

[Chelsea Clinton]

Look at us, we're so moderate, Trisha. We're so responsible. You really. Trisha, thank you so much. This has just been an enormous joy of a conversation. I didn't know we were gonna talk about toilet paper, but I'm so thankful that we did as well as talking about everything else. That I think certainly has taught me a great deal and I have no doubt will be informative and I also believe a fun listen to anyone who might be joining us. So really, really just incredibly thankful for your time today. Thank you so much.

[Dr. Tricia Pasricha]

Thank you so much, Chelsea. This was great.

[Chelsea Clinton]

You can learn more about Dr. Trisha Pasricha at Dr. TrishaPasrichaMD on Instagram and Dr. Trisha Pasricha on TikTok. And I hope you'll check out her Ask a Doctor column in the Washington Post. Thanks for listening. Talk to you next week. That Came Be True is a production of Limonada Media and the Clinton Foundation. The show is produced by Katherine Barnes Mix in sound design by Ivan Koraev. Kristin Lepore is senior Director of New Content and Jackie Danziger is VP of Narrative and production. Maggie Kralshore is our Managing Director of partnerships. Executive producers are Jessica Cordova Kramer, Stephanie Whittles Wax, and me, Chelsea Clinton. Special thanks to Erica Goodmanson, Sarah Horowitz, Francesca Ernst Kahn, Caroline Lewis, Sage Spalter, Barry Lurie, Westerberg, Emily Young, and the entire team at the Clinton Foundation. You can help others find our show by leaving us a rating and writing a review. And if you can think of someone who might benefit from today's episode, please go ahead and share it with them. There's more of that can't be true with Lemonada. Premium subscribers get exclusive access to bonus content with you. Subscribe on Apple Podcasts. You can also listen ad free on Amazon Music with your prime membership. Thanks so much for listening and see you next week.