Hey, it's your friend Mel, and welcome to the Mel Robbins podcast. The other day, I read this crazy piece of research. Did you know that two thirds of people have a gut issue? And you want to know the age group that is the most affected? This one really surprised me. 18 to 44 year olds? Yep. It's not your grandparents. It's 18 to 44 year olds. 73% of people in that age range have a gut issue. So if you're feeling bloated or you're constipated, or you have IB's or you're constantly popping the tums and you wish that you could do something about it, or maybe somebody that you love has one of these issues. Well, I have booked you and me an appointment with the number one gut health medical doctor. I think she's absolutely amazing. I'm talking 30 years of medical experience, and she's here to just set the record straight with the medical facts. She's going to say, throw out your supplements and the probiotics, because there are simple things that you can do, in fact, you should do, starting today, to have a healthier gut, to beat the bloat, settle your IB's, and address constipation once and for all, which you will also learn may be caused by a very surprising issue in your childhood.

And you're also going to learn the extraordinary role that your gut health plays in your immunity, energy, mental health, estrogen production, and so much more. This is a masterclass on your gut health, and absolutely everyone that you know needs to hear it. Hey, it's your buddy, Mel. I am so glad you're here with me today. It is such an honor to be able to spend some time with you today, and I want to acknowledge you for choosing to listen to something that can help you create a better life. I think it is so awesome that you're taking time for yourself, and I love spending that time with you. If you are a brand new listener, welcome to the Mel Robbins podcast family. I'm Mel Robbins. I'm on a mission to inspire and empower you with tools and the expert resources that you deserve so that you can create a better life. And I am thrilled to introduce you to a remarkable human being. Her name is Doctor Robin Chutk Ken. She is a renowned gastroenterologist who is the founder of the Digestive center for Wellness, which is an integrative gastroenterology practice where for 20 years, Doctor Robin has been working with patients to help them uncover the root cause of GI disorders.

She's been on the faculty of Georgetown Hospital for 27 years. Doctor Robin received her bachelor degree from Yale, her medical degree and residency at Columbia, where she was the chief resident, which basically means she was the top doc in her residency at medical school, and then she did a GI fellowship at Mount Sinai Hospital. Doctor Robin has also authored dozens of academic journal articles and book chapters, and she lectures frequently on the microbiome and gut health throughout the United States and Europe. She is also the host of the Gut Bliss podcast, the author of four best selling books, the Antiviral Gut Gut Bliss, the Microbiome Solution, and the gut bloat cure. And you're going to love her, and so will everyone in your family. So please, if you got a friend or a loved one who's been complaining nonstop about their stomach issues, this is a must share. So let's jump in and please help me welcome Doctor Robin.

I'm so excited to be here. Thank you so much for having me. We're going to go all things gut, not just the obvious things, but we're going to talk about gut brain, gut immune, how the gut is your engine for your, your entire body. It drives all the processes. And I think we're going to really give people a new way of looking at the gut and how powerful it is.

Absolutely. And what I also love about your work is you take all this science and distill it down into simple things that I can do. You listening? Are going to be able to walk out of here and know exactly what to do to take care of your health, to make your gut better. And you're going to understand why this matters so much.

I'm so glad to be here.

So, Doctor Robin, it does seem like everybody I know has a gut issue. Bloating and the IB's. I mean, are you finding that in your clinical practice, gut issues seem like they're on the rise?

They're absolutely on the rise. And as a gastroenterologist, you know, I've always seen a lot of gut issues, but if we look nationally, there was a study done last year by MDVIP and they found that two thirds of Americans suffer from gut issues. The highest number is in the 18 to 44 age group. Why 73%? I think a lot of it has to do with the food that they're eating. They're eating more ultra processed foods, they're busy, they're on the go. I think there's a lot of stress and that has a profound impact on the gut. And I think they're also more aware, which is good, right? I mean, it's good to be aware that, hmm, this isn't functioning properly. But that's the highest percentage. And what they found, the American Gastroenterological association did a survey and they found that 40% of Americans, and this is across the board, said that they had GI issues to the point where it was interfering with socializing, with running errands, with exercising, with having sex, with libido.

Wow.

And to me, the really frightening part of all of this is Aga launched a campaign called trust your gut around this. One in three Americans do not feel comfortable talking to their doctor about gut issues and will only raise it if the doctor asks. It's like, don't ask, don't tell because of embarrassment. And honestly, Mel, this was a reason. When I read this last year, I was like, oh, no, I've got to do something about this. I want people to be a medical detective like you. Turn around and take a look at that poo. You tell me what it looks like. If you need to poke around in it with a stick, understand? Why do you have gas? Why are you bloated? Why are you backed up? We have to educate people about how this works. And the education that I see out there is mostly the biohacking. Take this supplement, this crazy diet that's not fixing things for people. The more that we have, I think the sicker people are. What we really need is we need people to understand how the stuff works.

For the person who's listening, who is in the two thirds who are experiencing a gut issue, they love somebody who is what is available to them if they truly take to heart everything that you are about to share today.

Doctor Robin, not only is it possible for you to feel better in your gut, because your gut is your engine, it's possible for you to feel better in your whole body, for you to have a clearer mind and less brain fog, for you to feel less fatigued immune system, to work better so that you're not overreacting to things with food allergies or you're not underreacting to things where you can't clear infection. So the gut is a thing that unites all these different organs. And that's the thing that makes me so optimistic, because unlike when you think about genetic diseases, you sort of get what you get. You don't get upset, you're dealt a bad genetic hand. But our gut is changing all the time. When we think about our gut microbiome, which I know we're going to talk a lot about, we know from a study that was published in the journal Nature in 2014. They put people on a sort of heavy, high animal protein, high fat, Atkins type diet, and then they rested them for a week and they put them on a diet that was more plant focused. And they found that within 30 hours of the food hitting the gut, things changed dramatically.

The bacterial composition changed, the genetic composition changed in terms of the genes that were turned on and off. And the great thing here is you don't have to be a vegan. You don't even have to be a vegetarian. You just have to eat more plants. You have to do some basics. And in fact, the American Gut Project study from 2019 that asked the question, what do you have to do to have a super healthy microbiome? They found that the label was completely unimportant. Carnivore, omnivore, vegan, pescatarian, lactoivir. It was simply the number of different plant foods people ate. With 30 or more different plant foods a week being the magic number, you can have your porterhouse of whatever it is that you're going to have. I mean, all my vegan friends will be very upset. But from a health point of view, there are reasons to consider eating less animal protein in terms of the ethics and climate change, etcetera. But from a health point of view, you can definitely tolerate a little animal protein on the plate. You can tolerate a lot of things on the plate if you are crowding it out with enough of the healthy stuff, with some plants and some water and some movement and some of these basic things.

You just said 30 plants. So are you saying 30 different types of plants, or are there 30 ones that are better than others? Like as the gut doctor, what should I do?

30 different plants per week? And when I say plants, you get credit for fruits, vegetables, nuts, seeds, herbs, spices, beans, whole grains, all of them.

Oh, well, if we include spices and nuts and grains like that, absolutely. You could get 30 different things because I would imagine the variety. Is the variety also important?

The variety is important because they all contain different things when we think of these phytochemicals. So you think eating the rainbow is always a good way to do it. So you get different things from the oranges and you get the lycopene from the reds and you get something else from the green. And so eating a variety, eating seasonally, is another great way to do that, because you're not in the same sort of peas, carrots, broccoli. Heavy rotation. Yep. For, you know, 365 days. And it doesn't have to be a lot either. I mean, you're getting enough from, you know, a little handful of berries is plenty. You don't have to eat a whole quart of stuff.

So as the gut expert doctor Robin, what do you eat in a day? Will you walk us through like breakfast, lunch and dinner?

Absolutely. I like to start off with a green smoothie in the morning. Collards, kale, spinach, celery, parsley, mint, a little bit of fruit, usually green apple, lots of lemon. I like to use unsweetened coconut water for the base. So when I drink that, it's like a liquid salad in the morning. I mean, I feel so good when I have that. So I usually have that in the morning. If I'm still hungry, I'll usually have something high ish, protein, maybe a little bit of smoked salmon, some eggs, or maybe a sweet potato and kale hash. I love that too.

And then what do you do for lunch?

Lunch is usually soup.

Soup.

Soup person? Yeah, soup. And there are a bunch that I make. My husband makes really good soup too. So it's usually split peas or lentils. Sometimes it's just a broth. I do a really basic soup that's leeks, onion, garlic and scallion sauteed. And then I just blend it up with some broth. Delicious. Sometimes a little curry powder, depending on how I'm feeling. But that's all the good stringy, high inulin fiber. That's really good for your gut. Microbes. So some kind of soup. Sometimes it's a heartier soup. And then dinner is usually protein, starch, veg plus salad. My husband's mostly vegan. Not all the time. Special occasions, he might eat some meat. So he's usually not doing the animal. He's almost never doing the animal protein. He's usually doing lentils, brown rice, sauteed collards and salad. And I'll have all of that. But I may have a little piece of fish or some broiled shrimp or something. But it's lots of legumes, it's lots of beans and greens, basically, and then some whole grains. Love brown rice. Eat it probably most days. Love squash, sweet potato, yams, yucca, all of that stuff.

I wonder. You're glowing. This sounds absolutely amazing. So do you need to take a probiotic?

You need to eat an apple overtaking a probiotic.

Yeah.

This idea. And I will say for the record, there is dark chocolate happening every day for me.

Oh, thank God.

Tons of fruit and lots of dark chocolate.

Okay.

And I have been known to eat a bag of Doritos on a road trip. It has happened.

Okay, well, I knew I liked you, but let's talk probiotics, because they are everywhere. Everybody seems to be on one. And as the gut doctor, what's your opinion about it?

My opinion on probiotics is like multivitamins. Do we have Claire and compelling evidence that a multivitamin does anything for the average person? We don't. What we know from some studies is that people who take vitamins also have healthy habits. So vitamin takers tend to be exercisers and clean eaters and meditators, etcetera. But we don't have evidence outside of that, that the vitamin itself in a healthy person. So it may help. It can't hurt even something like a probiotic if you're taking multiple different species, those bacteria, assuming that there are actually live bacteria in the probiotic, because there's very little regulation, a lot of times the bacteria are dead. But let's say there are. Let's say the product does contain what it says it contains. These live bacteria, they are potentially competing for resources with other bacterial species, even the native ones in your gut that are actually working and trying to do their thing. And now they're like, oh, wait, there's not enough of whatever resources we need to eat. And so you can be altering your microbial composition for the worse by taking a probiotic.

Oh, God. Well, I feel like I'm in the camp of everything you just said. It can't hurt. And so I'll just keep, like, taking all these things and my body will just pee out whatever I don't need. So that's one mistake I'm clearly making. Second mistake that I'm making is I'm taking the probiotic and then I'm taking a different probiotic, and then I'm also eating the yogurt and the kimchi, and I'm just making this gigantic sort of bacteria salad.

But eat the kimchi for sure. I mean, we have great data on fermented foods, and a lot of this is from the Sonneborn lab at Stanford. So kimchi and sauerkraut are this powerhouse combination of pre, pro and postbiotics. And there's really compelling data that eating even a tablespoon of sauerkraut a day can provide multiple different species important metabolites. So this is ultimately sort of medicinal food, things like the sauerkraut and kimchi. So by all means, keep doing that.

Doctor Robin, what's the difference between a prebiotic and a probiotic?

A prebiotic is food for the bacteria. So that's typically healthy, fibrous foods. Probiotics refer to the actual bacteria themselves, not just the one you're taking as a supplement, but the ones in your gut. So probiotics are bacteria and prebiotics are the food that bacteria eat.

Got it. And I want to try to bring in a visual. So if you've ever made bread and you have that sort of, you're starting it and you've got the yeast and you then feed the yeast with the flour and it starts to bubble. The prebiotic thing is sort of like feeding the yeast and now the. Oh, I'm really hungry and I'm getting going. Okay, got it. And the probiotics, the actual other forms of the bacteria that you eat.

Correct.

Got it. So what are the foods that you need to eat to have both the prebiotic piece and the probiotic piece?

For prebiotic, which are the foods to feed the bacteria, think high fiber and think stringy fiber, like asparagus and celery, and also things like oats, dandelion greens. These are all great foods, fibrous foods. To feed your bacteria. For probiotic foods, think about fermented. They also contain prebiotic with a fiber. But think about fermented foods because those are producing bacteria during the fermentation process. I do want to say it's not that a probiotic is a total waste of time. In my practice, where I treat really sick patients with Crohn's and ulcerative colitis, there are probiotics on the market that have the FDA label as a medicinal food. This is a medical food for the treatment of inflammatory bowel disease, et cetera. They're products that have over 100 different scientific studies behind them showing that they work for these particular conditions. But that's different, right? That's like the b twelve for the Crohn's patient. That's not the average person. The data that the average person gets a lot of health benefit, or really any health benefit from taking a probiotic is a little murkier. And my concern is always that people are going to say, oh, I don't need to change my diet or really pay attention to that because I'm taking the probiotic.

I mean, you're actually eating the kimchi and doing all the other stuff, which.

Is fantastic, and I'm popping the probiotics.

I think you're probably okay, but you don't need it. But I do want to caution people, if you're taking these high dose probiotics, are you potentially using up resources that your native bacteria that need these resources.

How would you know, would you be bloated even though you're taking a probiotic? How would you know that it's backfiring?

You really don't. You really don't. There's not a test we can do for that. But what I want people to remember is that when you take a probiotic product, those bacteria may be living half an hour, I mean, typically under an hour. In order to get meaningful colonization and repopulation of the gut, you have to feed them. And so the food is ultimately more important because the truth is it's not that you don't have any healthy bacteria in your gut. The population is low. How do you get. Well, population may be low. Say you've taken a lot of antibiotics or you've had a crummy diet. How do you manipulate the microbiome and get those healthy species to grow? By feeding them, not by bringing in more species that are basically going to like hang around 20 minutes and then you're going to poop them out. So it's really this whole idea of repopulation and recolonization. And we do that by feeding what's already there. And that has been shown, and that's the american gut project study with the 30 different plants. When they ask the question, what is the most effective way? What is the most important thing to do to have a healthy microbiome?

And this is a study done in over 10,000 people, 40 different countries. So really meaningful data.

And the most effective thing was to get 30 different sources of plant based foods in your diet. Once a week?

Yes, throughout the week.

Wow.

So it's still really diet. I mean, if you look at an apple that's grown organically and even better, biodynamically.

What's biodynamically?

Biodynamically is when you have the animals fertilizing the soil from a local farm. I love it.

Gotcha.

That is exactly local because it's going to be more nutrient and micro rich because it's not travel 3000 miles on a plane and barely alive in order.

To keep the thing.

So an apple. An apple. You can get millions of microbes from eating an apple grown locally.

So Doctor Robin, I'm just imagining that the person listening is sitting here next to me. And we have come to you because we feel bloated or we're struggling with IB's or constipation or whatever. And so it is just kind of a classic, classic gut issue. What are the three small habits that you would like us to start implementing into our day to day life that are the best things that we could do that will build a healthy, beautiful kind of gut microbiome and get our gut system working correctly.

There are tons of things to do, but if I had to distill it down to three, I would say it's hydration, it's movement, and it's fiber. The movement, it's smooth muscle, it's not skeletal muscle. So it's not under voluntary control. But we know that movement creates nitric oxide, and nitric oxide is part of what keeps the heart healthy and keeps the gut healthy. The movement stimulates peristalsis. If you don't have things moving through in a timely fashion, not only do you have symptoms like bloating and constipation, but you also have stasis of those intestinal contents, and you have bacterial overgrowth, because things aren't moving through. So the movement is really important. And I found that since pandemic, so many of us are so sedentary. I know that I'm not at the hospital a few days a week anymore, back and forth, where I'm probably walking four or 5 miles every day. I'm sitting a lot more. And I think we've seen a huge effect of that, of the effect of being sedentary on the gut. So we need to stimulate gut peristalsis. The people we see with the worst GI problems are people in nursing homes, and it's not because they're elderly, it's because they're not moving.

So movement is really key. Hydration. I can't say it enough times. Plumbing. We've got to unclog those pipes. And then the fiber, because the fiber feeds our gut microbes so they can ferment that fiber, create all the healthy metabolites. And it doesn't have to be like some enormous kale salad. It can literally be, grab a carrot as you're walking out the door and jump on it. Throw an apple in your car, eat some nuts. Something basic, ideally something unprocessed. Right.

I love how accessible this is, because based on everything that you are teaching us, your body is naturally designed to work in the correct way. It is plumbing. It's trying its best. And so if you get all different kinds of plant based, fibrous foods in, the research says, try 30 different types of spices and foods, and that. And if you simply walk more, you're saying that that's three things that we can do that will help, over time, create a healthy gut.

Tremendous benefits tremendous. You know, the water thing is like a drug when you really start to. And I was one of those people who for years walked around sort of dehydrated. I mean, I drink a lot if I was at heated vinyasa flow yoga or running. But other than that, I was like, ah, I can't be getting up. I'm seeing patients. I don't want to get up every five minutes and have to pee. And then I started measuring and drinking 100oz of water. I noticed a tremendous difference. I mean, I already have pretty good poos, I have to say. If I can brag, I'll show you some pictures later, Mal. But these, I mean, just dramatic improvement. And they perk up like how briskly they come out because things are lubricated.

You know, I never thought I would say to a GI doc, I could listen to you all day, but I could. And there are so many people in my life, Doctor Robin, that need this information. And so I want to take a quick pause so we can hear a word from our sponsors. They bring you Doctor Robin at zero cost. So let's give them a little love. But you know who else I want you to give a little love to? The people in your life that need this life changing information. Those friends that are complaining about their stomach, the people that have all kinds of issues, send them this episode. It could really change their health and change your life. Alrighty. Don't go anywhere. We will be waiting for you after a short break with more from Doctor Robin. Welcome back. It's your friend Mel. And you and I are here with the incredible Doctor Robin Chutkin and we're learning all about gut health. I really do want to dig into having you help us understand specifically gut issues like bloating and IB's and some of the things that people really struggle with. But before we go there, I would love for you to explain to us why should we care about a healthy gut?

And what I'm trying to ask is, what is it impacting when your gut is healthy and when it's not? You said earlier that there's a big connection between your immune system and your gut health, which I didn't know. And so if you could just elevate this issue for us at the highest level, like why, beyond our plumbing working, does your gut health mean total health?

The gut immune connection is probably the most important connection for the gut and other organs. You have the gut lining, and on one side you have the trillions of microbes in your gut, your microbiome and on the other side, you have the immune cells, and that gut lining is only one cell thick. It's a razor blade separating your gut microbiome from the immune processes. And it's a hand and glove relationship. They're working together, literally. The microbes are like the lookouts, and they're like, oh, something problematic coming along. They trigger the immune system. In some cases, they actually kick on the lining of the gut. They push on it to trigger the immune processes. It's a physical interaction sometimes, but they signal the immune cells on the other side to say, oh, whoa, something big. Here comes Ebola or SARS. Cov two. You guys need to get ready. Mount an immune response, start making antibodies. T cells mobilize.

Let me just make sure I'm understanding why this matters. Because based on what you're consuming through your mouth that gets processed through this 30 foot tube, your gut is extracting intelligence that mobilizes other parts of your body to help you outside of this tube.

Yeah, absolutely. Your gut microbiome directs your immune system. It literally trains it. And this is why we see there's a fascinating theory called the hygiene hypothesis, and it was developed by David Strachan. He was an epidemiologist in Britain in the 1950s. He did a study of over 17,000 children from birth to adulthood. So for a long period of time to figure out why they were seeing these higher rates of autoimmune diseases in England and sort of post industrial London. And he found that kids who were exposed to more germs, who were living in large households where cousins and siblings were always sneezing and coughing on them, they were immunized because their immune system had been trained at an early age how to differentiate between friend and foe and whether to mount an immune response or not. How high an immune response? Kids who were super clean, who were never sick, they had higher rates of autoimmune disease later on. And Mel, if we look at a map of the world today, we still see the effects of the hygiene hypothesis. We still see high rates of autoimmune disease. In countries where there are higher levels of sanitation, there's more washing, there's more chlorination, there are more chemicals, there are fewer microbes compared to less developed countries where people have close contact with animals, they have close contact to the soil, they're growing their own food.

So the immune system needs exposure to microbes early on in order to train it so it can set it at just the right level. What we're seeing now in more developed countries like the United States is we're seeing an overactive immune system, which is manifest as autoimmune disease. One in four Americans, many people, have multiple or allergies, food allergies. Everybody's got an allergy.

Why? Why do we have a food allergy?

Because of an over reactive immune system. And why do we have an overactive immune system? Because of what's going on in our gut. But there is a very direct correlation.

Let me see if I can explain this to myself. So you're basically saying that when your gut is out of whack and it's getting all kinds of mixed signals, because if your microbiomes and the gut health isn't intact, it's actually not able to either break things down or read what's coming in correctly. And then that means it is not able to signal in an efficient and effective way to your immune system that either we got to go into battle, or everything is okay. And so because our guts are out of whack, we're not getting the hydration, we're not moving, we're not taking care of ourselves and eating the fibrous foods. This is causing our immune systems to go haywire.

Absolutely.

And this is so fascinating, and I actually, I actually read somewhere, I don't know if this is true, that 80% of people that, at least in the United States, that have an autoimmune disorder, or women.

Yes.

Why does this very, very high rate.

And gabor mate talks about this and other folks, we think it may have something to do with the effect of the female hormones, estrogen, progesterone, etcetera, and the interaction with the gut. And also because some of these genetic predisposers for autoimmune disease are sex linked. They're tied to the x chromosome. So a couple different reasons. I also worry about the personal care products, the cosmetics, the other things that women tend to use. More of that are getting absorbed into the body and how those might be affecting women. Because you think about it, you put makeup on at 10:00 in the morning, at 10:00 at night, it's like, where's the makeup? It's all gone. Where's it gone? It's got absorbed into our body. And again, I'm not saying that makeup causes autoimmune disease, let's be clear. But we put a lot of things on our skin, and after our GI tract, our skin is our next biggest digestive organ. Our skin literally digests the things we're putting on it. And so we have to also think what are we putting on our hair, our skin, etcetera, that could be getting absorbed into our body, that could potentially be triggering an immune response.

So that's just one of several theories. And like most diseases, like cancer, like dementia, it's not one cause, right? It's multiple different factors.

But is there research, or do you see in your clinical practice, if you are doing these interventions that anybody can do? Drink more water, move your body, eat more, like fibrous foods in your diet, when you can start to get your microbiome and your gut health and your plumbing working as it should, do you see an impact on an autoimmune disorder?

Most of what I do in my practice now is helping people with complex autoimmune disorders like Crohn's and ulcerative colitis get off immune suppressing drugs. And do you know how we do it, Mel?

No.

We do it with diet and lifestyle. And if you had told me 27 years ago when I finished my GI fellowship that I would be treating complex autoimmune diseases with food, I would have laughed at you and I would have said, haha, that's hocus pocus craziness. But now when I think about it, I think about my colleagues saying to me, does that stuff really work? And I'm like, are you asking me as a fellow gastroenterologist, if what you put into your gut affects what's going on in your gut? And you're asking me, is that how it works? I mean, of course that's how it works. What we put into our gut profoundly impacts what's going on in our gut, and what's going on in our gut profoundly impacts what's going on in the rest of the body. So, I mean, it is very contrary to the prevailing wisdom of all the biologics and the immunosuppressants you see advertised on television, and that's a gazillion dollar industry. But I will tell you, Melissa, we have published data on this, and we have a success rate of about 79% getting patients off of these biologic treatments. Now, I will tell you, it doesn't work in everyone, and it's a cherry pick population, because people are coming to see me, fancy GI Doc who, you know, they've got to travel out, whatever, come and see, and they're motivated.

But the intervention is what anybody could do.

The intervention is what anybody is, not. Any special diet you have to go and buy are products. We sometimes do use this very high potency probiotic, the one I mentioned that has the indication as a medical food for IBD. We'll often use that in conjunction, but it's always a dietary change. And I'll tell you the diet that I put patients on, what is the diet? It's similar to what I eat. It's a green smoothie in the morning. And I tell them, if you do nothing else, do this green smoothie. Get in your three leafy greens, a little celery. The parsley and mint are for me, just for flavor. Fruit ice, little lemon for taste. Get that in in the morning. And I usually start people on about 12oz. And then I work them up to 40oz of this green smoothie, okay? And it's all just stuff you buy at the supermarket. And I always felt like I was sort of alone out there in the wilderness, saying, you know, eat food, real food, it will make a difference. So, green smoothie in the morning. And I tell people, look, if you're still hungry, have some eggs, make an omelet, definitely have something else for sure.

And then for lunch, it's usually something based around plants. So I'll encourage my patients, I'll say, get a salad. That's usually easy for people to get. And if you want some animal protein, go for it. But make sure it's a big salad. And ideally put some chickpeas in there, some hummus on the side, so lots of plants. And then for dinner, if you are an animal protein eater, your protein, your starch, your two veg plus salad, and that's it.

There's the formula.

Sensible eating. And it's also getting people to cut down, or ideally eliminate the ultra processed foods, the packaged foods. With all the emulsifiers. In my neck of the woods for autoimmune diseases in the GI tract, we see that the emulsifiers, soy, lecithin, carrageenan, those things are particularly bad for the gut. And we think it's not so much a microbiome, but it's a gut lining that they compromise the gut lining in some way.

What are some other parts of your overall health that are driven by gut health that might surprise someone to know your estrogen levels?

I did not learn this in medical school. When I found this out a decade or so ago, I was mesmerized by something called estrobalome. And the estrobalome refers to a collection of bacteria in your gut that metabolize estrogen. So when the estrogen is made primarily in the ovaries and a little bit in the adrenal glands, and it travels through the bloodstream to all the different parts of the body that have estrogen receptors. And that's not just the uterus, that's also heart tissue, different parts of our brain, etcetera, that have estrogen receptors. And then estrogen that's not used gets transported. It gets into the bile and it gets excreted into the gut and it gets recycled through the gut. So there's certain bacteria in the gut that help to recycle, that some of it gets excreted out and some of it gets reabsorbed back through the lining into the bloodstream. If the estraboloum is disrupted, you get higher levels of reabsorption than you should, and you end up with a situation called estrogen dominance, where you have too much estrogen on board. That is associated with a lot of conditions, with fibroids, with endometriosis, with a lot of the menopausal symptoms we think of.

This isn't the only reason for sure, but this is. Most people don't realize that the gut plays a huge role in estrogen metabolism. So if you've been taking antibiotics nonstop for whatever they may have been prescribed from decades. Exactly. Not, I had a strep throat, I took antibiotics. But somebody put you on antibiotics for your skin, told you you have a chronic inflammatory condition, maybe rosacea, take these antibiotics, or because you're getting frequent urinary tract infections, take the antibiotics every time you have sex. And that could add up depending on who you are. So many of the patients I see, and so many women in particular are put on these suppressive antibiotics not to treat an actual infection, but to treat inflammation or to prevent an infection. And that ends up being ruinous to your gut bacteria, and that ends up affecting your estrogen metabolism and throwing your estrogen levels off balance, particularly for my menopausal woman and particularly because I'm menopausal myself, really focus, really take a gut centric approach to that to really look at. You've got to have a healthy gut if you want to go through menopause successfully. And there have been some really interesting articles.

Doctor Neil Barnard at the physicians committee for responsible medicine, and they're very much a plant based organization. They published a study that looked at a plant based diet for vasomotor symptoms and menopause for hot flashes, way more effective than hormone replacement.

Wow.

And the thing that I find in my patient population is it doesn't have to be a completely plant based diet. Now, Neil and his colleagues, who are wonderful people, would tell you that it should be, but you know, we live in the real world, and not everybody's going to become a vegan to control their hot flashes. But just eating more plants and eating a plant based dinner, having your last meal before you go to bed be primarily plants can help dramatically. If I want to induce a hot flash, I don't have them anymore. But if I want to induce one, I have a porta house steak and some red wine at night.

And I just say the same thing. I was just going to say the same thing.

Because digestion is such an active process, and particularly digesting animal protein that's high in fat, high in protein requires a lot of blood flow, a lot of enzymatic activity that leads to a lot of dilation and flushing. And of course, the alcohol is going to vasodilate you, too.

I think you just inspired me to make a major change, especially during the weeks that I have, like, a really big workload or I'm traveling for work. So I got to get up in the morning and give a big keynote in front of thousands of people. I always think, oh, I should have a steak tonight, I should have a piece of fish tonight. I should have a big protein thing to carry me through. And what I'm gathering from you is I would be way better off if I heavy loaded on the leafy greens and the vegetables and a lot of water at night because it would allow my gut to just flush itself and digest.

Yeah. And think about, I mean, the protein can be sating and it can carry you through, but think about having a high protein breakfast the day before, like, have an omelet the day before, or have more protein at lunch, but then for dinner, really lighten it up early. And light soup and salad. Perfect.

You know, I love this because so many of the experts that have come on, because you've been talking to a lot of people about, about hormones and menopause and for women in particular, how you age well so that you have energy and you're strong and you're able to be, like, vibrant and as you age. And so much of the message is about resistance training and just lots and lots and lots of protein. Right. And so I think really trying to get the big protein in the morning and at lunch is the way to go. But I'm learning so much. Can you explain the connection between the gut and the brain to the person listening?

The gut brain connection is another fascinating one, I think. Gut immune and gut brain right now, we have a whole separate nervous system in our gut called enteric nervous system. And it's many, many millions of nerve cells. In fact, we have about seven times the number of nerve cells in our gut that we have in our spinal cord. Not as much as we have in our central nervous system, clearly, but the gut is a very innervated organ. Lots of innervated, lots of nerve cells.

Okay, gotcha.

It also communicates directly with the brain via the vagus nerve, the 10th cranial nerve messages going back and forth. The gut also is where most of the neurotransmitters are produced. Serotonin, the feel good hormone dopamine, several others. Most of them are produced in the gut. They're co manufactured by bacteria.

I think that is a surprise to most people, because you hear the word serotonin and you think brain, but you're here to tell us, Doctor Robin. No, no, no. Your gut health is critical because the serotonin that you need, most of it is manufactured in a healthy.

In a healthy gut. So what we see is that with a disrupted gut, we see abnormalities in mood, in cognition, in memory, and conversely, because it's bi directional, it's gut affecting brain and brain affecting gut. We see the brain influence on gut motility, enzyme secretion, and absorption of nutrients. So you've got to have it in balance. And it's not either or. It's not either you take an SSRI or you eat healthily. It's both. And particularly for young people, the idea that you can take a young person who's struggling with mental health issues, and they can be eating cheetos and cheeseburgers while you're medicating them and you're not paying attention to what they're eating is magical thinking. We have to pay attention to that for brain health.

Also, is there a scientific link between depression and anxiety and gut health?

There are. And like a lot of these conditions, it's multifactorial. But I'll give you just a basic example. There's a bacteria called campylobacter jejuni, which is a common cause of foodborne illnesses. And sometimes people will get it with a traveler's diarrhea when they're out of town or something. In mice, if you inject a large inoculum of campylobacter jejunae, you induce anxiety in mice. What's a human correlate for that? Post infectious irritable Bowel syndrome, which is what we refer to when somebody has a change in bowel habits. That's happening after an infection, often after an infection like campylobacter jejuna. Post infectious, irritable bowel syndrome doesn't just affect your bowel habits. Where now the bowel habits are irregular. Maybe they're looser, they're more frequent. It also frequently involves changes in mood. People will say they're more anxious. You know, I went to the Caribbean. I got traveler's diarrhea. I was in Mexico. I got montezuma's revenge, and I came back, and my bowel habits haven't been the same. But I also find I'm more anxious. My mood seems to have changed, and we think a lot of that is mediated through the change in the microbiome.

Wow. Let's talk about iB's, because I have a number of friends and family members that are struggling with it. So what should somebody do if they think they have ib's? What would you say? These are the steps I would take before you go running for some sort of drug.

Number one is you have to figure out what is causing it. And I like to think in terms of general categories. So is it something mechanical if you're a woman? When was your last ultrasound? Do you have a big fibroid? Could there be endometriosis? Do you have an anteverted uterus or a prolapsed bladder or something that's pressing on it? What is the anatomical, mechanical thing going on that could be causing symptoms?

Okay.

Medicine cabinet is a big one. And it's not just prescription drugs, but it's also over the counter and supplements. So you need to look at the side effects.

And what am I looking for?

All of them. You're looking for things that have GI side effects. Nausea, vomiting, diarrhea, constipation.

And isn't that every medication?

It's a lot. But I'll tell you, when they list side effects, they list the most common ones first. It's like ingredients at a food label, right. So the most common ingredient is listed at the top.

And by common, you mean this is the. This is the side effect we see the most.

Exactly.

Okay.

Yes. So if you see nausea, vomiting, abdominal pain, constipation, diarrhea in the top five and you are having some of those symptoms, that's something that's worth checking out. And again, not advocating that you take a drug holiday on your own, but talk to the prescriber. And here's the thing. Your psychiatrist might be prescribing a drug for you for anxiety. And the drug may be helping your anxiety, but it may be causing a whole different problem in the GI tract. I have to remind people that just because something is helpful doesn't mean it's a good idea. And I tell people all the time, if you're tired and I gave you some cocaine, it would pep you right up. But does that mean cocaine is a good idea for treating fatigue? So in my practice, I spend so much time trying to undo sort of medical misadventure, I like to call it, where a very well meaning physician prescribes something for his or her neck of the woods, a kidney problem, a psychiatric problem, a lung problem. And it's going great for that problem, but it's messing up my organ now. So we're very siloed in medicine.

The nephrologist is the kidneys and the pulmonologist is the lungs. And everybody's just sort of focused on their thing. And because the medicine cabinet is such a problem in the GI tract. And as you said, mel, but don't all these drugs have GI side effects? Many of them do because you ingest them. So they potentially affect the ph of the gut, they potentially affect the gut lining, and they potentially affect the gut microbiome, and then those things affect the immune system, et cetera. So it becomes a sort of whack a mo, like, you whack one problem, hair. Your high blood pressure, fantastic. Blood pressure is controlled. Now we have a problem over hair, so we whack that with another medicine. And so it's polypharmacy. And when I see people, the first thing I want to figure out is, is this a side effect I'm treating? Because it often is, right? So is there constipation or their bloating a side effect of a medication they're taking? And the sometimes challenging thing is people don't want to hear that. They want, like, the magic potion, like, give me the magic supplement probiotic that's going to make the cell go away.

So I have people bring their medications, their over the counter, the supplements, everything, and I lay them all out on the table. And the people in my office always laugh because I always have my rubbish bin right next door because they're like, oh, this is going to fill up. And I'm like, okay, this one. What's this one for? And to be clear, I would never tell somebody to stop a prescription medication that I didn't prescribe. I tell them, this one you got to talk to your prescriber about. But I divide it up, and usually by the time I'm done, it's a pretty small group.

That's like, what is kind of the first thing that you're like, no. No Advil? No. Aspirin? No. This, like the thing that people take.

All of you got it. The nonsteroidal anti inflammatory drugs.

What is that?

Advil, anosin aleve, ibuprofen. So when we look at the emergency visits for gastrointestinal bleeding, number one, cause too much. Too much ibuprofen.

Wow.

People don't realize that over indexing on this stuff can cause fatality, gastrointestinal bleeding. There was not a weekend on call when we were not in the intensive care unit with our scopes trying to stop dramatic, near fatal gastrointestinal bleeding.

Wow.

So these drugs can be potentially really dangerous. You have to be careful with them.

And I'm assuming that if this is kind of the detective work you're doing, that it's still the same three things that you would recommend in terms of movement and water and diet to overcompensate.

But you can't fill a bathtub with the stopper out. Right. So if you're trying to improve gut health, fill the bathtub. You have to make sure that it's stopped up, that you're not draining all the good stuff you're doing out. I like this concept of personalized medicine, but personalized medicine, not in the sense of, like, you know, all these wonky tests and supplements, but personalized medicine in terms of sitting down and really figuring out what are the things that you're dealing with and what is a background noise, what is a platform on which your symptoms or illness live? Is that platform standard american diet? You know, only eat a broccoli florette once a week as your only vegetable? Is it massive amounts of antibiotics in childhood, as was the case with my daughter? Is it really sedentary and no time outside. So you've got to look at that platform, see what you can change, and then start to add on. Right. You don't just start adding on all the medication without really and even thinking about the other medication. How are these four other medications you may be taking for high blood pressure or something else?

How are they affecting the liver?

As I'm listening to you, I'm not only thinking about myself and the person listening, but I've got at least five people that I have to send this episode to, like, right now. And so let's take a quick break so we can hear a word from our sponsors. And while you're listening, listening to the sponsors, share this episode with your friends and with your family. Anybody that's been complaining about stomach or gut issues, they need Doctor Robin in their life. So send them this episode, and don't go anywhere because we'll be waiting for you after a short break. Stay with us. Welcome back. It's your friend, Mel Robbins. And you and I are here with the incredible Doctor Robin Chutkin. And you and I are learning absolutely everything related to gut health and more importantly, how to make it better. So, Doctor Robin, here's where I want to go next. One thing that I want to talk about with you today is poop. Like, what should we be looking for? What's healthy?

What's not my favorite thing to talk about. And Mel, I am so curious about your poop, if you are willing to share. I know I'm not the only one who wants to know. Like, what are Mel Robin's bowel habits? Like?

Well, I'm the kind of person you ask the question, I'm gonna tell you, so I'm happy to talk about my poop.

I have a feeling that you have wonderful poos. Cause you just. You have this glow. You seem really healthy.

Okay, do you really wanna know?

Yes, I really wanna know.

So I am a once a day person.

Excellent.

I typically go in the morning, and I have one of those little stools that.

The squatty potty.

Yep. That you put up. And if I can't find a stool, like, if I'm at a hotel, I pull the little garbage can over, pick my feet up. I have, like, a very. I think it's healthy. I mean, I don't even know what healthy poop is. I just know that when it comes out kind of in one shape perfect, and it's somewhat soft and held together, and there's not a lot of strange objects in it, that that's probably healthy. I don't like it.

Like.

Like, if I have a situation where I'm not doing well and I'm super stressed, I might go go a day without pooping, but typically never more than a day or two. And then when that happens, it looks like milk duds, and I know I'm in trouble, and I'm not healthy. How am I doing, doc?

Stool nirvana, baby. Is that what you got it? Stool nirvana. You hit all the. So daily good color formed, and it also sounds like you feel good when it comes out, right? There's that feeling of, like, yeah, I emptied, I detoxed, I'm good to go.

And I'm pretty efficient. Like, I don't spend a lot of time in there. I can get in, I can get out. But that does beg the question how often should you be going, how often do you eat?

Do you eat every day?

Of course.

At least once a day? Yes, you should be eliminating once a day. So this idea, we have this textbook definition that it's three or more bowel movements a week is normal, but if you're going under three, you're constipated. It's a very arbitrary number. And when we think about constipation, we're usually thinking about things like consistency. Is the stool hard or is it soft? How much is coming out? But it should absolutely be a daily thing because that's what it is. It's elimination. It's eliminating dead blood cells, it's eliminating bacteria, toxins, et cetera, undigested food particles. That stuff is not supposed to be gumming up your colon, just sitting there, right?

Everybody that does not go number two once a day just leaned in and thought, oh, God, well, what do I do? So if you're somebody that is not going once a day that doesn't have kind of a satisfying experience with this or kind of reliable, what are the first couple steps that you want somebody to do?

I think the first thing, again, is recognizing that this should be daily. Now, that being said, if you skip a day here and there, your traveling schedule is a little bit different. That's nothing to worry about. But how can we help people go every day? So I want people to consider a couple things. What they're putting in, how they're stimulating the gut, and that's primarily with movement and what they might be doing that's slowing things down, the gut motility. So what you're putting in, you want to make sure you're putting in enough fiber. You want to make sure you're putting enough water, liquid. It's plumbing. The GI tract is pipes. In fact, a plumber was at my house one day fixing something, and I was standing over him and he kept looking at me and he was like, you know, are you checking what I'm doing? I'm like, no, no, no. We're just in the same business. You just make a lot more money than I do. So I'm just looking at what you're doing here. But it's plumbing. It's one long pipe from north to south, about 30ft long, and things get clogged along the way.

And what do you do when your pipe is clogged? Thin liquids, lots of water. So I tell people my rule of thumb, half your body weight in ounces of water as a minimum. And that's just plain water. We don't need electrolytes in it. We don't need flavoring. Those things often are irritating to the gut. So just plain water, half your body weight in ounces of water as a minimum, and that makes a tremendous difference. I can probably solve 50% of the constipation I see in my office just by getting people to hydrate.

Wow.

And by the way, as you know, great for your skin and everything else, right? So so many of us are walking around dehydrated.

So takeaway number one is thinking about your gut system as a 30 foot long plumbing system. It starts with your throat moves all through your body and right out the chute at the, you know, at the bottom. And that half of your body weight is what you should be hydrating with, just plain water every day. And as a medical doctor specializing in this, 50% of constipation issues can be solved by simply hydrating crickets.

I mean, it's a generalization, but 50% of the people I see in my office who are bloated, unconstipated, and, you know, things are sluggish. When I get them to really start hydrating, things perk right up. I also want to point out that the female plumbing system is very different from the male plumbing system. Oh, wow. Three main reasons. So if you have had a colonoscopy, if you're 45 or over, you should have had a colonoscopy, and you may have been told, particularly if you're a woman, that you have either a redundant colon or a tortuous colon or a twisted colon. And the reason that's more common in women is because of anatomical differences. So, number one, we have a longer digestive tract. Our colons, on average, are about three to five inches long. Longer.

Why?

Well, that, first of all, it may not seem like a lot. It's like three to five inches.

Like, if you think five inches, that's, like, from your rear end of your belly button.

Exactly. It is a lot. And that extra length creates more looping and twisting, and so things are more likely to get stuck. And that's one of the main reasons women tend to be so much more bloated and constipated. The reason why is to allow for more fluid absorption during pregnancy. So, fluid, the colon does two things. It gets a product of digestion from north to south. Well, it does more than two things, but two big things. And then it also reabsorbs water from the inside, from the stool, through the lining of the colon, into the bloodstream. So the reason that women have a slightly longer colon is so that when we are pregnant, we can reabsorb more water through the colon to maintain the amniotic fluid.

Let me just see if I can extract that so that those of us without your amazing medical knowledge and degrees understand this, because I think that's fascinating. So did you just say that one of the things that your colon is doing is when the waste is moving through your colon? The colon is actually removing water and moisture from the waste matter and recycling that water through your body so that, as a woman, you can make the amniotic fluid, you can do other things that are part of the reproductive cycle.

100%. And so when, if you were to go up into a colonoscopy, as somebody is having a bowel movement, which I don't recommend, we like to have the colon cleaned out when we're doing that. What you would see is that when the stool hits the top of the colon, it's liquid.

What?

It's liquid and it's green. It's bilious fluid. And as it moves through the five to 7ft of colon at the end, the fluid gets reabsorbed so that what comes out at the end is a beautiful mel Robbins stool. Nirvana. Chocolatey brown. Gorgeous. We need to make some t shirts for you that say, I have great poops.

Oh, my God. I don't know if I want people looking in the toilet and going, that looks like Mel Robbins right there. Mel RoBbins smiling right back at you. Yes.

So at the end, you get this chocolatey brown thing. So how do you turn liquid green at the top of the colon to solid brown at the bottom? The colon reabsorbs the fluid and all the bacteria that are primarily in the colon. You have bacteria throughout your whole gi tract, but they're concentrated at the bottom. The bacteria get dumped in the dead bacteria and the dead red blood cells, and that turns it brown. And so that process happens in the colon. The absorption of nutrients, the vitamin A, d, e and k, the iron, all that stuff gets absorbed upstream in your small intestine. So the function of the colon transport the products, reabsorb water, ferment the products of digestion with all the gut bacteria, so that you end up with a chocolatey brown stool.

This is fascinating, isn't it? I mean, it is so fascinating.

Poo is so fascinating. So the longer colon is just reason number one. Reason number two, why we're more bloated and constipated, is that we have a deeper, wider pelvis. The female pelvis is called a gynecoid pelvis. And the male pelvis is an Android pelvis. What that means is that our colon falls deeper down into the pelvis, where it has to compete for space. What else is in the pelvis? Your uterus, your fallopian tubes, your ovaries, your bladder. That's a lot of hardware in men. They just have a prostate gland that's about the size of a walnut. So there's much more room. If you look at two skeletons side by side, male and female, you can tell the female the pelvis is like wings, and the male is straight. And again, what's the reason? Childbearing. So that we can accommodate a whole human being down there. So that's reason number two. So these are both sort of anatomical reasons, right? Longer colon. Deeper, wider pelvis. Reason number three, we have lower testosterone levels. Okay, well, what does that mean? Testosterone does a lot of things. And again, you know, it's not that we don't have any, but we have less.

And one of the things testosterone does is it. It makes the muscles in the body kind of stronger, more rigid. So men have a tighter abdominal wall because they have more testosterone. So even a man with a big, bare belly, he'll complain about having a bare belly, but he won't complain about being bloated, because underneath his bare belly is a nice, tight Spanx. And we've got a stretched out spanx because of the lower testosterone levels. These three things really consider to bloat and constipate us. And if you look at the medical literature, you'll see all these articles about why colonoscopy is harder in women. It takes longer. We require more sedation. And that's true, but it's not because we have a lower pain threshold. It's because we have all these anatomical things that, you know, are there for a reason. They're not a design flaw, but they also conspire to make us more backed up.

Can we talk a little bit about constipation?

I love talking about constipation.

Why do you love talking about constipation?

Constipation is so satisfying because there's so, so many different things that cause it. And often people are dealing with two or three things, and when people feel better, it's like, ugh, you know, they're so happy. And the other reason I love treating constipation, sorry to interrupt, is because bloating is constipation's fellow traveler. And so when people are constipated, they're almost always bloated. Because they're just plugged. And so when you relieve the constipation, you de bloat. Bloat them, and they're thrilled. And the other thing is, a lot of people who are bloated don't even realize they're constipated. You can have a bowel movement every single day and still be constipated. You can have two bowel movements a day and be constipated if you are having something called incomplete evacuation, Tenesmus. And Tenesmus is like the new insomnia. So think about it. When we think about insomnia, we think, okay, I have trouble falling asleep, but most people who have insomnia don't have trouble falling asleep. They go to sleep fine, but they wake up and they can't go back to sleep. I mean, I know that's my issue. I go right to sleep and I pop awake and I start ruminating and I can't go back to sleep.

Well, constipation, Tenesmus is kind of like that. It's not that you're not going. You're having a bowel movement, but it's incomplete. And you can tell that your colon isn't empty. You know, you've got that, like, that kind of feeling. Like, I still got something on the launch pad. Yeah. And often it's a schmerry wipe because when you wipe and there's still a lot of stool on it, that's because there's stool still in the rectum that hasn't come out. So you don't have that good clean wipe where it's like, ah, look, nothing on the toilet paper. That's part of stool. Nirvana is a clean wipe.

So what? So you said that there were lots of different causes and lots of different things you can do. So can you walk us through the things that cause constipation that might surprise people?

It's very similar to the irritable bowel syndrome to the IB's classification. So mechanical. Do you have a voluptuous venous colon? Do you have fibroids? Have you had surgery and you have scar tissue? Tissue. Do you have a prolapsed bladder or rectum? So what's going on mechanically? Medicine cabinet. I think I beat that horse to death. And then hormones. Do you have potentially undiagnosed hypothyroidism? Do you have. Are you early menopause and now you're more constipated because of that? And remember, perimenopause starts like, ten years before you stop having your period. So could it be a hormonal problem? Could it be a physiological motility problem? And the motility is very tied to the composition of the gut bacteria. So, believe it or not, antibiotics that you took ten years ago and affected your microbiome can now be causing your gut to slow down or go too fast and not function properly.

I have somebody that I love that is chronically constipated and will go four or five days, and that is consistently, consistently what their experience is.

And what do you think the reasons are? Have you. Have you done any sleuthing?

I have, and it's a very healthy person. Exercises all the time, has a very clean diet, does not take any, like, not a lot of medication. Young, and I personally think it is an issue with the muscles and not, like, somehow training yourself to clench when you should be releasing.

It's a huge category, and I'm so glad you brought it up, because I had overlooked that when we were talking about it.

Can you describe what this means? Because I think for people that also have a shy. That you're shy about pooping around, the.

Medical terms are things like anismus, and some of these are pelvic floor issues. And I know you've had pelvic floor people on, but it is tightening when you should be releasing. And what we're talking about here now isn't really a pelvic floor issue. It is a muscular issue, and it's exactly what you said. Shy bowel. The technical term is parkopresis. It's also called psychogenic fecal retention, and it's classified as a psychiatric problem. But there's some really important physiological things that make me think it's misclassified as a psychiatric problem.

So could somebody have constipation? And you actually have shown eye bowel, like, hundred percent there, and you're so combated, and you're like, I got. Why can't I get, like. And then as you're, like, stressing and tensing, you're actually in this almost, like, traumatic response to pooping because you're so stressed about being constipated. Is this, like, a thing?

It's the immediate stress, but more. More so. It is what happened before. So people who tend to hold their poo in. So you have to have a bowel movement, but there's not a good bathroom, or you don't have time. You're at the airport, and you're worried that your flight's gonna board without you, or you're at school, and the bathroom's gross. And there's space between the door, and people can see and hear and smell, and, you know, there's noise associated with it. It's one of the most important things for bowel hygiene is to not have stalls, because even people like, I am the least shy about bowel movements. But, I mean, I don't want to have a bowel movement in public, but I don't care. I'll be in the stall talking to you. That's not really normal. Most people do not want to be in a bathroom with four stalls having a bowel movement, talking to somebody on the other side of the door, they're like, no, they want privacy. Having a bathroom where you have a toilet and a door that closes and not stalls, hugely helpful for good bowel habits because a lot of people will be comfortable going to the bathroom in that setting.

So you have these two muscles. You have the internal sphincter, which is under involuntary control, meaning it's going all the time. It's clenched tight to prevent leakage. And then you have the external sphincter, which is under voluntary control. And that's the one that you open or close depending on whether you're trying to push the stool in or out. Now, when the rectum fills with stool, the internal sphincter relaxes to let the stool out. And that's when your external sphincter is supposed to push it out. But if you decide, oh, this isn't, you know, I don't like the look of this bathroom. I'm at a train station. I'm going to wait. You're clenching when you should be releasing, and that completely confuses the sphincter.

So you can train your yourself to hold it in and not realize you're doing that 100%.

So that creates something called reverse peristalsis, where the stool is going back up in the wrong direction instead of coming out. And so if you do that often enough, and often this happens in children, it's more common in girls, we tend to be a little bit more fastidious about where we use a bathroom. If you do that often enough, it means that when you actually want to have a baby movement, you can't because the sphincter is confused. Like, the internal sphincter relaxes, but now the external sphincter is clenching. My best advice for people is if you have tried everything for your constipation, you did the fiber and the water and this and that, and you exercise and you do all these things and nothing is working. Consider some of these mind body practices, whether it's cognitive behavioral therapy or it's internal biofeedback, which is a kind of physical therapy. Find a biofeedback practitioner, it could make a huge difference. And the keys for, for me, one clue is on the rectal exam, I'll say, oh, yeah, this person definitely has anismus. And another clue is when somebody says, I've done all of these things, and not only is it not working, it's making me more bloated because the sphincter at the very bottom is tight, and so all the fiber and the water and everything is all backed up right at the back door, but the door won't open.

So what is the. How do you know if you're blind loaded versus you're just gaining weight?

Yeah, that's a really challenging and sometimes uncomfortable conversation to have with people. But a really useful way to know is to take a tape measure and measure right around your waist, generally just around your belly button, in the morning and at night, every day for about a week. If there is a lot of variation in that number, that's likely bloat because. Because bloating ebbs and flows and it's usually gas, but it can also be liquid and solid. If it is belly fat, that number typically won't vary by more than an inch. And sometimes people come and they have an apple shape, skinny legs, big belly, and they think they're bloated. And on exam, I can also tell because fat feels different. And when you auscultate and you percuss and tap and you auscultate and listen, I can tell fat from gas. But if somebody's out there and they're not at the doctor measuring the waist and seeing if it ebbs and flows and people will send me pictures. And typically it's flat to fat from morning to night, so they're flat in the morning, and then they send me pictures at the end of the day and they're super bloated.

What are some surprising foods that cause bloat? That we might not know cause bloat?

Yogurt, yogurt, yogurt. Because somewhere between 60 and 70% of the world's population is lactose intolerant. And some people know it because they have really smelly gas. And it's immediate. But many of us lose our ability to digest dairy over time because we're not baby cows, so we're not really meant to be or designed to be drinking this. The lactase enzyme is along the brush border in the small intestine. And if you have an acute infection that can knock it off and you lose it. And just as we age, over time, people might have tolerated dairy really well, and now they're not. Or their dairy would mostly be cheese and yogurt and things that don't have as much lactose. They're not drinking big cups of milk. But dairy is one that a lot of people think of as a health food. And it can be right, it's a fermented food and so on. But so often people are not tolerating the dairy. And so they're having all this yogurt it every day. It's a convenient, quick, portable, delicious source of protein. So many of my patients, I'll see some form of dairy, either yogurt or cottage cheese, or trying to get their protein up every day.

And we get rid of that, things improve a lot. So that's something to, and not for everyone, but for a lot of people, it's dairy.

Are there some surprising everyday non food things that can cause you to be bloated?

Yes, there are. One of the things to remember with bloating, I mean, we think about the GI tract and elimination and stool and liquid and gas, but it's also our lymphatic system. And our lymphatic system is like a fluid that bathes our cells and it has to drain. And exercise is what stimulates lymphatic flow. So if you're sitting for a long time and you may notice it just if you're sitting for a long time, your feet swell. But why do your feet swell? I don't know, because the venous flow, the veins are occluded because you're sitting and there's pressure on the veins and the lymphatics don't move as much. Much. So moving around exercise, really important for lymphatic flow, really important for de bloating. And then there's things like salt in the food, alcohol. And alcohol is a big one because it irritates the gut, that can lead to inflammation, that can lead to fluid retention, it also dehydrates us, and then that causes fluid to shift and puffiness, things like that. But exercise is another big one for blood.

When somebody comes and sees you, Doctor Robin, and they just are really, really bloated and it's not a big serious issue, it is something that they're experiencing. Is there like kind of like a step by step protocol that you're like, do this and do this and you should be feeling relief in a matter of days?

I love putting people on a liquid diet for a couple days and using some magnesium citrate. Now I want to say, with the magnesium citrate in the liquid, the bottom, you gotta make sure there's no kidney disease and other things going on. But let's say this is a typical healthy person. They went on vacation, they over sported themselves. In the words of my mother in law, they ate a little too much, they drank a little too much. They, you know, they. Most of us come back from vacation feeling a little constipated.

Why is that? It's because we've just been like, woohoo.

It's because we've been woohoo. And also, if we've crossed time zones, that we often feel jet lag in our gut. It slows down. And also because our GI tract is a creature of habit, you know, now you're in a strange bathroom somewhere, and so our bowels get a little shy when we're traveling. So my favorite thing in that situation is to put them on two days of a clear liquid diet, which could be broth and tea and green juice as opposed to a smoothie, and do that for a couple of days. And a little bit of liquid magnesium citrate at night, not too much. We don't want things like a teaspoon. No, no, no. The typical bottle of magnesium citrate is about a soda bottle. So maybe a quarter of that, a.

Quarter of that, a quarter of that.

So like a cup of the liquid magnesium citrate. Make sure if you haven't taken that, that you know where the bathroom is. Because magnesium citrate, for some people it will work overnight, and for some people it could work like regularly in a couple hours. Yeah, so I like that because again, the stimulant laxatives that have Senna, things like that, those are really hard on the colon. Colon can become dependent. Some of them have an impact on the microbiome. That isn't great. The liquid diet, you know, that is a great way to sort of reset, to decompress. Most of the time when your colon is uncomfortable, stop eating liquids, it works great. And you see, with animals in the wild, when they're sick, they stop eating. You won't see a dog who picked up a parasite chowing down on their food. In fact, that's often how we know they're sick. In addition to the fact that we're looking at their stool, they're not eating. That is still really helpful. What we call NPo, nothing per orum, nothing by mouth. And it doesn't have to be that extreme, but going to liquids and eating less to allow whatever it is to come out.

And that could be true even for something that's infectious. If you have a mild case of infectious diarrhea, a foodborne illness, and your GI tract is trying to expel that, and you're having diarrhea and you're vomiting, and it's trying to eliminate it, don't go adding a whole bunch of food on top of that. Right. And make it harder. If your GI tract wants to empty, let it empty, get it all out, and then start again. So that's my favorite thing, is just to do a little mini clip cleanse.

How does stress impact our gut?

Stress has a huge impact on our GI tract. We talked about the gut brain connection and the neurotransmitters, et cetera. But stress triggers our sympathetic nervous system, and that's our fight or flight. A parasympathetic nervous system is our chill out, rest, and digest. If you think about having to get away from the tiger that's chasing you, you need the blood flow to go to your brain and the large muscles in your. Your body, your quadriceps, your hamstrings, so that you can run and get away from danger. Digestion itself is a very active process. It takes a lot of enzymatic activity, a lot of blood flow. So when you are stressed, all the resources are diverted away from your GI tract. And so stress can really impact digestion negatively, because it will affect not just the way the digestive enzymes are secreted, it can decrease acid secretion, it can decrease other digestive enzymes secretion. But we know stress can also increase the population of unhealthy microbes. There was a famous experiment that was done in college students, and it found that during finals, certain more pathogenic bacteria could increase a thousand fold in an hour. Just start multiplying and multiplying and multiplying.

And you think about when college students are stressed. They're not sleeping, they're not eating well, they're over caffeinated, and now their microbiome is out of whack. So stress has a really profound impact. The question comes up a lot male with people who have irritable bowel syndrome, particularly folks where there hasn't been one or two more specific causes found, and they want to know, well, is stress causing this? What I find in the GI tract is stress isn't usually the entire reason, but it can be a really major contributing factor.

What are symptoms that indicate that there may be something more serious going on with your gut.

Doctor Robin, red flags in the GI tract are really important. And those would include things like blood in the stool, weight loss, vomiting, abdominal pain, not like a little discomfort, but, ooh, that really hurt. Those are the things. Unrelenting nausea. Those are the things that I would say get thee to a gastroenterologist and quickly for those things.

Doctor Robin, you have this ten day plan for a better gut, and you call it the gut bliss method. Will you walk us through it?

Yeah, I call it the gut bliss method. And it consists of removal, removing, replacing and restoring. So the first part is to remove foods, practices, medications that are potentially harmful to your diet. So that would be things like ultra processed foods, alcohol, nonsteroidal anti inflammatory drugs and excessive antibiotics. And for practices, it may be something as simple as not taking enough time to have a bowel movement. So removing those things and the idea behind that is kind of like the bathtub. If you're going to fill the bathtub, you got to make sure the stopper is in. You don't want to be trying to fill a bathtub with a stopper out because you're eating foods, taking medications that are still causing a problem. So that's removed. Replace is trying to add in those extra healthy bacteria, not through a probiotic, primarily, but through exposure to nature, through fermented foods that we talked about. The powerhouse combination of pre pro and postbiotics and those sorts of really healthy, high fiber and fermented foods to replace the gut bacteria. And then the restore is how do you restore overall health? And a lot of that focuses on mind body practices, on getting outside, on getting quiet, reducing stress.

And of course, hydration is a big part of it. So it's simple. It's stuff that anybody can do. It's not expensive. I mean, you need access to some good food and you need to actually eat it. But what I find, whether I'm seeing a patient who has complicated Crohn's disease or somebody who's just a little, little bloated, it is incredible how much of a difference these basic principles make. And I came up with them over. It's been a couple of decades of practice. And not to say that some of the fancier things don't play a role also, right. But what I find the majority of the time, it's really getting people to pay attention to these foundational things that they can do. These are not things that require a gastroenterologist. I mean, you may need to go to the gastroenterologist for the evaluation, for sure. Particularly if you have alarm symptoms. But these are things that anybody can build into their everyday routine. And I know that it doesn't sound super sexy. Well, where's the fancy magical food and supplement? But believe me when I tell you, Mel, I have done thousands of colonoscopies, seen thousands of patients in the 30 plus years since I graduated from medical school.

And these are the things that make a difference. And the beautiful thing is you can see a difference quickly. You may not be able to reverse your autoimmune disease quickly if that's part of the goal, but in terms of that tangible return on investment that your gut is going to give you when you sit down and you have that stool nirvana for the first time and you're like, damn, is this what it's supposed to feel like? I just detoxed in the most profound way.

I freaking love you. I feel so smart and I literally want to go to the bathroom now and just like, enjoy, enjoy having a poo. I would love, Doctor Robin, for you to talk directly to the person listening because you have been so generous and have poured into us. There was so much that you taught us that you equipped us to be able to do. If there was one thing that you really want them to remember, that they walk away and that they implement today, what will that be?

Eat more plants. Eat more plants. You don't have to be vegan or vegetarian or any of it, but plant fiber is the most important food for our gut microbiome. It doesn't mean there are not other things that aren't helpful and it doesn't mean the other stuff you're eating is bad. But we have to feed our microbiome, we have to nourish and nurture it. And we do that with plant fiber, whether it's just a carrot stick as you're going out the door, or an apple that you throw in your bag, or it's more complicated lentils bowl. Eat more plants.

You know, Doctor Robin, I often remind everyone that some of the best people that you will meet, you haven't met yet. And I just love you. I feel like you literally walked into my life and we are going to be lifelong friends.

And for the record, you were already super smart before I walked in here. You already knew so much stuff. People need to understand how their body works. We're kind of alienated from our body and we're really alienated from our gut. We don't even want to look in the toilet. I'm like, how can you not look in the toilet? It's like tea leaves, like it's telling you something. This is really important evidence and feedback. Like, you can't just flush it and ignore it. And we do that because we still have this sort of victorian sensibility about cleanliness and stool, and it's dirty. And so really understanding how this stuff works, and for me, helping people to understand, and this is really the focus of the last book, the antiviral gut, that, yes, our gut is a digestive organ, and digestion is really important. But our gut is also a defensive organ. Stomach acid isn't just there to digest food. It also kills pathogens. Our gut lining literally protects us from pathogens so that bacteria and viruses can't penetrate and get into our bloodstream and travel to the rest of our body. Our stool eliminates not just waste matter, but toxins.

So there's a huge defensive element to our gut. And if we want to stay healthy, we got to keep these defenses going. We got to protect these defenses and understand them. So I'm so grateful to have a chance to come on and explain all this stuff.

Well, I'm so grateful that you're here. And so the person that was listening to us didn't just feel smarter, they felt seen. They now understand themselves. And more importantly, you know what to do, and you know why this can work and why you're. It matters. And that means some of nobody's going to try it. And the simplicity of it is also something that I really love, because, let's face it, we're all busy. If you can't fit it into your already crazy busy life, you're not doing it. If you can't remember it. When you stop listening to the two of us, you're not going to be able to do it. If you can't share it with your friend who has irritable bowel syndrome, or your son or daughter or your husband who has a problem with constipation, if you can't remember what to tell them and why it matters, you're not going to be able to help them.

Absolutely.

And so I so appreciate, appreciate spending this time with you. I would sit next to you in a public bathroom in open stalls and chit chat all day. And so, thank you. What are your parting words?

I want people to remember that when they have these symptoms in the GI tract of bloating and constipation and heartburn, so often these are not illnesses that are just falling out of the sky. This is your gut trying to communicate with you. It is knock, knock. In the case of heart. Heartburn. Why did you have that porterhouse steak at 11:00 last night? And the two glasses of red wine? You should have had that at 01:00. Had a salad at night. So it is your GI tract giving you feedback. Why is it giving you feedback? To keep you alive. To keep you healthy. To protect you. To try and prevent you from doing it again. But what do we do? We don't listen. We just block acid and keep on going. Now, there are of course, these alarm signs, blood and severe pain and so on. But most of the symptoms, the common symptoms, indigestion, the constipation, the bloat, these things. It is your GI tract saying knock, knock and trying to communicate with you. And my whole goal is to translate this stuff, to basically teach people gut language. Let me tell you what your GI tract is saying and how you can respond.

And once people do that, they don't need me. And that's the goal, right? I'm superfluous. I'll just see you at the farmers market. Hey, what's up?

Or in a public bathroom.

Exactly. We'll be chatting. Should not. If somebody is continuing to come and see me year after year after year, aside from chronic autoimmune diseases, it means I'm failing. I'm not doing my job. If I were seeing you for constipation ten years ago and you're still constipated, you should fire me. Because I needed to have given you the tools I needed to have translated for you so that you now speak gut ease and you understand. And you know exactly what to do.

Doctor Robin, thank you, thank you, thank you. And thank you for tuning in for sharing this. I know you're going to share this with so many people in your life. Didn't you freaking love her? And for the record, I would be next to you in a public bathroom stall too, talking off my, like, whatever with you. Because I love you. I believe in you. And what I'm so excited about is you now have world class medical facts and understanding from literally the number one expert on this so you can empower yourself from the inside out to activate the natural intelligence of your body. And you now know all the health implications and how positive it is. So go do it. Share this episode please. And I can't wait to see you again soon. One. Action. I love it when she says that. I already feel like you're my new best friend.

I already feel like you're my new best friend 100%.

Because we're gonna talk for like, sympathetic fight or flight.

Parasympathetic rest and digest. Yes. Yeah.

Oh, wow. Starting today, that will help you. Oh, my God. Sorry. Oh, shit. Okay, I gotta go back up. I didn't realize that was in. Okay, so long. You're fucking amazing. Oh, my God, you guys. Wow. Oh, and one more thing. And no, this is not a blooper. This is the legal language. You know, what the lawyers write and what I need to read to you. This podcast is presented solely for educational and entertainment purposes. I'm just your friend. I am not a licensed therapist, and this podcast is not intended as a substitute for the advice of employment, a physician, professional coach, psychotherapist, or other qualified professional. Got it? Good. I'll see you in the next episode, Stitcher.