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

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.

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).

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).

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).

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).

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).

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).

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]

"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]

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]

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]

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.

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.