Moment 195: 10 Things Your STOOL Says About Your Health: The No.1 Poo & Gut Scientist

0:00:02 (upbeat music)
0:00:07 – I read in your book that 60% of poop is bacteria.
0:00:08 – Yeah.
0:00:09 – Which just blew my mind.
0:00:11 – Yeah, and I think that this is an important conversation
0:00:14 to have because we have stigmatized poop.
0:00:16 We’re not allowed to look in the bowl.
0:00:18 We should be looking in the bowl.
0:00:22 And the reason why is because if I were a cardiologist,
0:00:25 I would come over and I would check your pulse.
0:00:26 I would listen to your heart.
0:00:29 And those vital signs would allow me to have an idea
0:00:32 of how you’re doing in terms of like just on a basic level,
0:00:35 your cardiovascular health, all right?
0:00:36 I’m a gastroenterologist.
0:00:38 If I want to know the basics of what’s going on
0:00:42 with you and your body, I need to know how you’re pooping.
0:00:44 – So let’s close off on this subject of poop.
0:00:48 My team actually prepared some poop samples earlier on
0:00:52 because I was wondering as a gastroenterologist,
0:00:55 I wondered that if you could look at someone’s poop
0:00:56 and determine whether they have good gut health,
0:00:58 and if you can understand what’s going on in their body,
0:01:00 just by how their poop looks,
0:01:02 because poop comes in many shapes and sizes.
0:01:07 So what I have here is a variety of different shapes
0:01:11 and sizes of poop for anyone that can’t see.
0:01:12 We’ll look at the screen
0:01:15 if you’re listening to this podcast on Spotify or YouTube,
0:01:18 different shapes and sizes of poop here.
0:01:19 This is real human poop.
0:01:23 So I’m gonna pass you that so you can play around with it.
0:01:24 – Yeah.
0:01:28 – And why does the shape and size of our poop
0:01:29 tell us anything?
0:01:30 Why does it matter?
0:01:31 And how is it indicating something
0:01:33 that’s pertinent to our overall health?
0:01:35 – Well, because it goes back to what you mentioned earlier,
0:01:39 which is that 60% of the weight of our stool
0:01:40 is actually microbial in origin.
0:01:43 So if you want a window into your microbiome,
0:01:44 look at your poop.
0:01:47 You don’t necessarily need to go and do an expensive test.
0:01:48 Like quite simply looking at your poop
0:01:51 is one of the ways that you can tell what’s going on.
0:01:54 So there was a study that was done in the ’90s,
0:01:58 a long time ago, and it was less than 2,000 people,
0:02:00 exclusively in the city of Bristol.
0:02:03 And it led to the creation of a chart
0:02:05 called the Bristol Stool Scale.
0:02:07 – Right here, I’ll put it on the screen.
0:02:10 – Yeah, and we’re gonna run through this.
0:02:12 But before we do, I wanna mention a few things real quick
0:02:14 as the US medical director of Zoey.
0:02:17 I’m proud of my contribution as a gastroenterologist
0:02:20 as a physician to the work that we’re doing there.
0:02:22 And we not only did the blue poo study,
0:02:24 which we’ve talked about already,
0:02:26 which is that you can eat your muffins
0:02:28 and figure out your gut transit time.
0:02:29 But we also did a couple of other things.
0:02:31 One is called the blue poo challenge,
0:02:36 where we had over 20,000 people across the planet
0:02:38 who were basically eating blue muffins
0:02:41 and then reporting back to us on what was going on with them.
0:02:42 And then more recently, so again,
0:02:46 the Bristol study was 2,000 people exclusively
0:02:48 in the city of Bristol.
0:02:53 We recently did the largest study across the entire UK
0:02:55 on poop and what people were doing
0:02:57 in terms of their bowel movements.
0:02:59 So it was called the big poo review.
0:03:02 And we had 142,000 people from across the UK
0:03:05 basically fill out a 17 question survey.
0:03:06 And part of what we were looking at
0:03:08 was their Bristol stool form.
0:03:10 We were also looking at how often they poop.
0:03:13 By the way, the average person poops 1.7 times per day.
0:03:16 And we were also looking at like how it associates
0:03:18 with different conditions.
0:03:21 So as an example, one in five people in the UK
0:03:22 are constipated.
0:03:25 One in six people in the UK have diarrhea.
0:03:27 So it’s interesting to take a look at all these things.
0:03:30 So now getting into the Bristol stool chart,
0:03:35 the dream. – That is real poop.
0:03:38 – This is, it’s lovely.
0:03:41 This is the dream.
0:03:43 This is where we all want to be.
0:03:44 And this is a Bristol four.
0:03:46 The Bristol four is the classic
0:03:50 where I come walking out of the bathroom in slow motion
0:03:52 and rock music is jamming
0:03:54 and doves are flying in slow motion.
0:03:56 And I just am such a stud.
0:03:57 So, and that’s after a Bristol four.
0:03:59 My wife knows what happens
0:04:00 when I come out looking like that.
0:04:02 It’s soft and formed, okay?
0:04:06 And it’s like a sausage or a torpedo.
0:04:07 So pretty smooth.
0:04:11 Now, when we move from a four to a three,
0:04:14 a three is not that big of a deal.
0:04:17 But it is getting some cracks and crevices in it, all right?
0:04:19 So, and we’re moving towards constipation.
0:04:23 Now, a three, you know, a little more fiber,
0:04:25 a little more hydration, some exercise.
0:04:27 These are simple things that can help to get you back
0:04:30 to a four if you’re having one of these, a three.
0:04:32 But that moves us to a Bristol two
0:04:35 where we are truly getting into constipation territory here.
0:04:37 And basically, this is like,
0:04:39 if you took a whole bunch of marbles of poop
0:04:41 and jammed them together.
0:04:43 So it still forms into something,
0:04:45 but it looks like a pack of marbles of poop
0:04:47 that are stuck together.
0:04:49 So that’s a Bristol two stool, that’s constipation.
0:04:52 And then finally, a Bristol one
0:04:54 is when you’re having the rabbit pellets
0:04:57 and they’re hard and they’re not easy to get out.
0:04:59 And sometimes they’re a lot bigger than this.
0:05:00 These are small.
0:05:05 So you would form this up into what would be like a golf ball.
0:05:10 And that golf ball would be like a Bristol one.
0:05:11 Okay.
0:05:16 All right, you form it up into a hard ball like this,
0:05:18 but perhaps even bigger.
0:05:20 And it’s actually hard for a person to pass this.
0:05:22 It’s so big, it’s so hard
0:05:27 that your bottom has a problem relaxing to let it out.
0:05:31 Okay, so Bristol one and two are forms of constipation.
0:05:32 Let’s go back to the middle.
0:05:33 We’re gonna start from five.
0:05:35 The stool is soft.
0:05:38 It’s not hard, it’s not lumpy bumpy, it’s soft.
0:05:41 But it’s starting to break into blobs,
0:05:42 different pieces of poop.
0:05:46 So, and we’re moving towards,
0:05:49 we’re moving towards diarrhea
0:05:53 where like just like fragments of solid stool
0:05:55 are a Bristol six.
0:05:56 And then when it’s just like,
0:05:59 or the other thing a Bristol six could be like a cow pie,
0:06:02 where there’s no form.
0:06:07 It’s just someone plopped down this formless patty.
0:06:12 And a Bristol seven finally is straight liquid,
0:06:13 straight liquid.
0:06:17 And how is this pertinent to our gut microbiome, our health?
0:06:18 What does this tell us about our health?
0:06:20 There’s been now multiple studies,
0:06:23 including our work at Zoey on the Blue Poop Study
0:06:24 that was published in the Journal of Gut.
0:06:26 There’s not been multiple studies
0:06:27 where basically what they found is that
0:06:30 if you can look at which of these Bristol types you have,
0:06:31 it does give us some insights
0:06:35 into your gut microbiome and what’s happening there.
0:06:37 So now where do we want to be?
0:06:38 In a perfect world,
0:06:41 we want to be somewhere on the spectrum of three,
0:06:42 four or five.
0:06:44 We ideally want to be a four.
0:06:49 You’re not unhealthy if you have a three or a five.
0:06:51 So if this type four poop, which is kind of like a sausage,
0:06:56 it’s kind of like a smooth sausage is optimal.
0:06:57 How does one do that?
0:06:59 What is turning it into a type four?
0:07:00 What are they eating, doing?
0:07:02 Yeah, interesting question.
0:07:07 We, one of the things that we found in the Big Pooh Review,
0:07:10 which is our nationwide survey of 142,000 people,
0:07:12 we actually looked at what they were eating.
0:07:16 And we were able to find associations between fiber intake
0:07:19 and specifically plant-based food intake
0:07:20 and having a number four.
0:07:21 So in other words,
0:07:24 we found associations between fiber intake
0:07:27 and basically plant-based food intake and having a number four.
0:07:29 So basically what that means
0:07:31 is the people that were having a number four bowel movement
0:07:34 were consuming more legumes, whole grains,
0:07:36 fruits and vegetables.
0:07:37 The people who were having,
0:07:39 whether it be a type one or a type seven,
0:07:42 they actually were quite similar in terms of their diet,
0:07:45 which is that they actually were consuming
0:07:47 lower amounts of fiber.
0:07:49 Now, the other thing to look at too,
0:07:53 is actually some studies have found
0:07:57 that people who have more on the spectrum of constipation
0:07:58 tend to have a higher fat diet,
0:08:01 tend to typically consume more animal products,
0:08:04 which of course are higher in fat.
0:08:06 And people that are more on the loose
0:08:09 or diarrhea side of things,
0:08:12 tend to be consuming more plant-based foods.
0:08:15 So now you could have a very healthy diet
0:08:17 and be having a Bristol five.
0:08:19 And that actually is not problematic.
0:08:22 And the reason that you’re having the Bristol five
0:08:24 is because you’re consuming so much fiber
0:08:26 that actually you’re producing a lot of short chain fatty acids
0:08:28 and those short chain fatty acids,
0:08:30 they’re like lubricants for your poop.
0:08:33 And the gut transition time,
0:08:35 how does that relate to these different types of poop?
0:08:38 As you were saying that, I was thinking the one in seven,
0:08:39 the type one and the type seven,
0:08:41 the type one being those sort of hard nuts
0:08:43 and the type seven being basically diarrhea.
0:08:47 I was assuming that those are the poop types
0:08:50 that would happen with a lower
0:08:51 and a super high gut transition time.
0:08:52 That’s right.
0:08:53 So a slow gut transit time,
0:08:56 which is a gut transit time more than 58 hours.
0:08:58 So again, and this is all with the blue muffins.
0:09:00 You eat the blue muffin,
0:09:02 it comes out 58 hours later.
0:09:04 You are more likely to be having a Bristol one
0:09:05 or Bristol two,
0:09:08 which is the classic constipation form.
0:09:10 There’s no way,
0:09:12 no way that you would have slow gut transit time
0:09:14 and have a Bristol seven.
0:09:15 That’s not possible.
0:09:16 A diarrhea.
0:09:17 Yeah, a diarrhea.
0:09:18 So diarrhea comes out fast
0:09:21 and these sort of hard nuts they take typically a long time.
0:09:22 That’s right.
0:09:24 And the reason why this is happening,
0:09:27 you know, so when water moves through the intestines,
0:09:29 ’cause a ton of water moves through the intestines
0:09:32 and one of the jobs that our colon has,
0:09:36 the Vargentestin is to pull the water out.
0:09:41 So the more time that something spends inside the colon,
0:09:42 the more it’s actually going to do that,
0:09:43 pull the water out.
0:09:46 This is the reason why when we have fast transit,
0:09:48 it’s high in water.
0:09:49 And this is also the reason why
0:09:52 when it’s slow transit, it’s extremely dry.
0:09:54 Okay, so that’s the shape and size of the poop.
0:09:56 But what about colors of poop?
0:09:58 I’ve got some different colors of poop here.
0:10:00 I’ve got some red, some blue, some black,
0:10:01 some green, some whites and some yellows.
0:10:02 Yes.
0:10:05 How is color pertinent to health
0:10:06 and everything we’ve been discussing?
0:10:07 All right, let’s break this down.
0:10:09 So first of all, why is our poop brown?
0:10:13 The answer to that question has to do with bile.
0:10:15 Bile is produced by our liver.
0:10:19 It’s actually involved heavily in digestion of fat.
0:10:22 So when we, for example, eat a fatty meal,
0:10:24 our gallbladder will squeeze.
0:10:25 People that have gallbladder issues
0:10:26 know what I’m talking about.
0:10:29 You eat a fatty meal, your gallbladder squeezes.
0:10:32 Bile then mixes in your intestines with the food
0:10:34 and the bile helps to absorb the fat.
0:10:39 That bile is what makes our poop brown.
0:10:40 Now that becomes particularly relevant
0:10:43 if we’re talking about a white poop.
0:10:44 People poop white?
0:10:46 Some people poop white.
0:10:46 No way.
0:10:47 Yes.
0:10:51 And the reason why a person would have a white poop
0:10:54 is if there’s a blockage that stops the bile
0:10:56 from mixing with their intestines.
0:11:02 On the flip side, if you are struggling to process your fat,
0:11:04 you could have a yellow poop.
0:11:06 So, and this could be a person
0:11:07 who has like a pancreas issue, for example,
0:11:09 chronic pancreatitis.
0:11:13 And so if they’re not able to digest their fat,
0:11:17 they have a fatty poop, it may come out yellow.
0:11:18 And one of the things that they’ll notice
0:11:22 is that there may be an oil slick at the top of the toilet bowl.
0:11:24 That’s fat, oil is fat.
0:11:26 So, all right, you’ve never had a,
0:11:27 have you ever had a green bowel movement?
0:11:28 None of your business.
0:11:30 (laughing)
0:11:32 It’s the damn question.
0:11:33 I haven’t, man.
0:11:34 Okay.
0:11:35 I have.
0:11:36 Oh, really?
0:11:37 Yeah, there’s a couple of reasons.
0:11:39 Some are healthy, some are not.
0:11:42 So you could have a, you could have diarrhea
0:11:44 like from an infectious cause.
0:11:46 An example could be something called Giardia,
0:11:48 which is a parasite.
0:11:49 And that’ll give you a green poop.
0:11:52 But you could also go too hard on the smoothies.
0:11:55 I was drinking like 40 ounces of green smoothies a day
0:11:56 and my poop would come out green.
0:11:57 It’s interesting.
0:11:59 We’re about to get into some that are really important.
0:12:02 Before I do that, let me just mention real quick,
0:12:03 the blue, so the blue poo.
0:12:08 You could get a blue poo from eating blueberries,
0:12:10 particularly if you eat a lot of them.
0:12:11 Or alternatively, of course,
0:12:14 this is the blue muffin, the blue poo challenge.
0:12:16 So, and perhaps what we could do in the show notes
0:12:17 is give people the recipe
0:12:19 for how they can go about doing that
0:12:21 if they’re interested.
0:12:23 All right, red and black.
0:12:27 So we have to talk about, let’s start with red.
0:12:30 Because of course, red, we think about blood.
0:12:34 And I have a rule, which is that if you see blood
0:12:37 in your stool, that’s not normal.
0:12:40 And to me, that’s grounds to talk to a doctor.
0:12:43 And then there’s different levels of intensity
0:12:45 of how seriously we check it out.
0:12:50 But Steven, colon cancer, which can present with red stool.
0:12:54 Colon cancer is the number two cause of cancer death
0:12:55 in our countries.
0:13:01 In the United States, 150,000 people are diagnosed per year.
0:13:03 It’s highly preventable.
0:13:06 And it’s shifting towards younger people.
0:13:10 There has been a change in the last few years
0:13:14 in terms of colon cancer, where as an example,
0:13:17 a person of your generation,
0:13:18 you and I are pretty close, I think,
0:13:20 but I’m a little bit older.
0:13:24 Person of your generation is four times more likely
0:13:27 to be diagnosed with rectal cancer during their lifetime
0:13:29 than my parents were.
0:13:33 And twice times more likely to be diagnosed
0:13:37 with colon cancer compared to my parents’ generation.
0:13:39 So there’s been this shift,
0:13:41 and it’s also affecting younger people.
0:13:44 So my point is this, I’ve had patients who come to me,
0:13:46 they go, “I saw a little bit of blood in my stool.”
0:13:49 Do a colonoscopy and discover
0:13:51 that they have a massive polyp,
0:13:53 which is a precursor to cancer.
0:13:55 And by removing the polyp,
0:13:59 we just basically stopped them from developing cancer.
0:14:02 So I take it seriously when you see a poop
0:14:05 that is coated in red.
0:14:08 All right, now that red may be just on parts of it,
0:14:12 like it is here, where that’s typically bright red
0:14:13 coming from the bottom.
0:14:16 So that would be either something in your rectum,
0:14:20 could be hemorrhoids, could be an anal fissure,
0:14:23 could also be a polyp in the rectum.
0:14:23 Okay.
0:14:24 But I think what I come back to is,
0:14:26 I would encourage people to get checked out,
0:14:28 because just seeing the bright red blood
0:14:29 doesn’t mean it’s hemorrhoids.
0:14:31 Don’t assume that, right?
0:14:33 Particularly with cancer shifting towards younger people,
0:14:35 I think it’s important to get checked out.
0:14:37 On that point about cancer shifting towards younger people,
0:14:39 is that because our diets are changing?
0:14:41 I think so.
0:14:44 I think it’s the shift generationally
0:14:47 that’s taking place in terms of our diets.
0:14:49 I also think that there’s a microbiome element.
0:14:52 The connections between the gut microbiome
0:14:57 and colon cancer are as powerful as any type of cancer.
0:15:01 And at the same time, what protects us?
0:15:03 And I think you know what I’m gonna say,
0:15:07 it’s the fiber and the short chain fatty acids.
0:15:09 And in that study that I was mentioning earlier
0:15:12 from Andrew Reynolds, the professor from New Zealand,
0:15:15 actually there was a powerful association
0:15:17 between fiber consumption and protecting ourselves
0:15:19 from colorectal cancer.
0:15:21 So powerful that for every gram,
0:15:24 five grams of fiber that we increase in our diet,
0:15:26 we are getting a significant reduction in our risk.
0:15:29 So it’s not just do you eat fiber or not,
0:15:30 it’s actually how much fiber do you eat
0:15:31 and the more the better.
0:15:33 You know what I should mention real quick,
0:15:37 red stool can also come from eating beets.
0:15:39 It will almost always happen like literally,
0:15:42 24 to 48 hours after you eat the beets.
0:15:43 So don’t be surprised when that’s the case,
0:15:46 you may see a little bit of red stool.
0:15:49 Black stool can come from benign places.
0:15:51 So an example is bismuth.
0:15:53 So like Pepto-Bismol.
0:15:55 So you have a stomach ache
0:15:57 and then you take some Pepto-Bismol.
0:15:59 And so, but the issue with this
0:16:01 is it’ll actually give you black stool.
0:16:03 So if you’re having a bad stomach for a couple of days
0:16:05 in a row, it could turn black.
0:16:07 But the other thing that turns your stool black
0:16:11 that people need to know about is a slow GI bleed.
0:16:14 Bleeding into your stomach specifically
0:16:17 because that bleeding is happening higher up
0:16:19 in your intestines and then it has to pass
0:16:22 all the way through like intestinal transit time, right?
0:16:23 Because there’s such a delay
0:16:25 by the time it gets down to your rectum,
0:16:27 it’s now black, it’s not red anymore.
0:16:30 So black stool can be indicative of bleeding.
0:16:33 The way that we can differentiate this
0:16:37 is when it’s blood, it smells terrible.
0:16:38 Oh, now we’re gonna start smelling our own peep.
0:16:41 Yeah, well, you don’t have to stick your nose into it.
0:16:44 It’s so clear, like it would be so clear.
0:16:45 Okay, okay.
0:16:48 When I’m in the hospital, I will be walking through
0:16:50 and I can literally tell when a consult is coming
0:16:52 because I can smell this diagnosis.
0:16:54 Really? Yeah.
0:16:58 So anyway, the stool will turn black.
0:17:00 It will smell terrible and it will be like tar.
0:17:01 That’s what makes it different
0:17:04 than if you were to, for example, take Pepto-Bismol.
0:17:06 (funky music)
0:17:09 (upbeat music)