August 10, 2016
[0:17] The New Podcast Format
[1:13] Blue Apron
[3:39] Harry’s Razors
[4:46] Onnit Emulsified MCT Oil
[6:07] Michael Phelps and Cupping
[10:05] A Study and The New Supplement Stack – HMB and ATP
[11:58] Introduction/ About Dr. Robynne Chutkan
[14:17] Books: The Microbiome Solution and The Bloat Cure
[16:25] How Dr. Chutkan can “smell” gut issues
[20:18] Two kinds of sweat glands/ why sweat smells funky
[24:41] What pig whipworms and hookworms have to do with getting a healthier gut
[33:40] Why the Bedouin tribe eats camel feces when they have gut issues
[36:05] Fecal Mirobiota Transplantation and Clostridium Difficile Infection
[37:32] How Do You Know If You Had The C. Diff? What Causes C. Diff?
[46:49] Do People’s Personalities Change When They Get a Stool Transplant?
[52:32] What about Poop Pills?
[55:28] Which Common Musculoskeletal Imbalance can cause Constipation
[58:14] What is Anismus?
[1:02:21] Colonic Dysmotility and Other Causes of Constipation
[1:07:46] Is Wine Good or Bad for your Microbiome?
[1:09:34] The Best Time of the Day to Take Probiotics If You are Also Taking Antibiotics
[1:12:45] A Tip to Make Beans More Digestible
Ben: Welcome to the Ben Greenfield Fitness Show! Not just any show but today, a show about pooping. If you wanna fix your gut, fix constipation, optimize your digestion, (I’m gonna trademark that term) optimize your digestion, you do wanna keep listening.
And a few other things: first of all, we are switching the podcast format up a little bit in case you didn’t hear. Meaning, in case you aren’t stalking Ben Greenfield fitness on Facebook. Basically, we’re gonna do one kinda like slightly longer interview every Wednesday, and then also alternate that with our normal Q and A super specials every other Wednesday. That will be something that we slowly, gradually roll in to here going into whatever it is, the fall of 2016 or as all my cool business friends say, the next quarter. This also means that when I release this longer, slightly more detailed interviews for you, I will have a chance to go over a few things prior to giving you the actual interview.
And I promise, this will be super quick but I have been getting some questions specifically about Michael Phelps and cupping. That is the question number one I’m getting a lot of a feedback on. And then the other thing I’ve been asked about is this new study about something called HMB and ATP for getting 20 to 25% gains in power and strength, and lean muscle.
So we’ll talk about that in just a second but before we do that, I wanna ask you a question about Succotash. Succotash. I grew up when I was a kid watching Looney Tunes cartoons, and I always remember that I used to say “Suffered Succotash”, “Suffered Succotash”. And I never knew what Succotash was. I knew what Succotash is now because Blue Apron, our sponsor for today’s podcast on this week menu sent Seared Cod and Summer Succotash with fairy tale eggplant. I didn’t even know fairy tale eggplant existed but it does. And pickled grapes. These are the type of things that I get sent to my house as a member of Blue Apron.
Basically, what they do is they send all the ingredients to use. Now, like a pre-cooked meals, you don’t feel like a lazy ass in there eatin’ these meals somebody dropped off for ‘ya. No, no, no. They send you the ingredients and you get to learn a ton about cooking by making it yourself, but these are healthy and delicious meals that wind up costing you less than 10 bucks a meal and all the ingredients are fresh and high quality, and artisanal, artisanal – whatever that means. And they’re wild caught, they’re heirloom. Heirloom and artisanal, two words that I throw around that I have not a clue what they mean. Anyways, you can get Blue Apron and you can try it out for free. How do you do that? How do you check out this week’s menu and get your first two meals free? You go to blueapron.com/ben. It’s just like it sounds b-l-u- e, blueapron.com/ben. They call it a better way to cook and actually they do great. It’s really cool.
The other day I was travelling and that’s what I am getting ready to do right now, I’m headed down to the Ancestral Health Symposium, literally in a couple of hours, I’m hopping out a flight to Boulder for the Ancestral Health Symposium. Google it if you don’t know what it is. And then after that I am off to Salt Lake City to compete in the Train To Hunt National Championships where I’ll be shooting giant foam elk and running around in the mountains with a weapon crawling in the barb wire for a couple of days.
Anyways though, on my last travel I forgot my razor and I had actually get one from The Holiday and Express, bless your heart Holiday and Express, I had to get one there. Little like front desk razors, and it reminded me how much shaving sucks when you don’t have a good 5-blade ergonomic flex hinged lubricating strip razor which is what I usually shave with. It is the Cadillac of razors. I get it from this company called Harry’s, and what they do is they cut up the middleman like the drugstore or the hotel front desk, and they send you a razor straight to your door or whatever it is that is in the front of your house. You go to harrys.com, if you go to harrys.com and you use code Ben at check out, you’re gonna get 5 dollars off, and here’s what I would recommend, you get their Truman. It’s 15 bucks, you’ll get the razor handle, (did I mention it’s ergonomic and heirloom), moisturizing shave cream, and 3 of their 5-blade German engineered razors. So harrys.com and then enter code Ben at check out.
And then finally, should you listen to today’s episode on pooping and you need something that would help you poop even more, that would literally blow up your pants if you drink the whole bottle. Get yourself some MCT Oil. No, I’m just kidding, don’t drink the whole bottle, you will have a diaper moment if you do that. But there is this company called Onnit and they’re making an Emulsified MCT Oil. I’m getting to throw around all sorts of big words today. Emulsified, what does that mean? It means that they’ve made it so you don’t have to blend it with stuff like coffee and tea when you add it because it’s emulsified. All that means is you just put it in there and it mixes it. It emulsifikize, emulsificates, emulsifies every time you add it to anything: smoothies or shakes or teas or coffee. MCT Oils are great for you. It upregulates your production of ketone bodies which can result in enhanced cognitive performance, enhanced energy for endurance, et cetera, but they’ve got some really good flavors. They’ve got strawberry, coconut, vanilla, heirloom tomato, (no I’m just kidding), they don’t have heirloom tomato. But you get 10% off of it. You go to onnit.com/ben10. That’s onnit o-n-n-i-t dot com slash Ben10 to get 10% off. All their supplements in there, they’re functional foods.
Okay, couple other things. You guys and girls, people on Twitter really, I don’t know. People in their mom’s basement on Twitter. I’ve been getting lots of questions about Michael Phelps. You may have noticed in the Olympics, you get to listen to this at the time of the Olympics that he had weird purple circles covering his right shoulder. And there’s a bunch of other folks competing in the Olympics where you see these circles especially on Team USA.
Well, those are not giant hickeys from the Olympic village which are for just one big wild sex party. No. They are indeed purple blotches leftover from the practice of cupping. Now, I’ve had cupping done to me before. I’ve had it for low back pain, I’ve had it for IT Band friction syndrome, and what you do is you actually place a cup over the section of the body, and that cup which is usually like this little glass cup is then heated or they’re sometimes use like a vacuum-based suction. It dries the skin upward so it creates the vacuum inside that cup over the target area of your skin. And if you remember when you’re a little kid, you’re like suck on a cup and make your lips like pursed out if you suck for a cup for long enough. Maybe I was the only kid who is a cup sucker.
Anyways, so what happens is it pulls all that skin out and when it pulls the skin out, the idea is it will improve blood flow to different areas. There is even a form of cupping that results in bleeding, like you cup for so long that you bleed to get a detoxification effect. They’ve got this really cool one called Fire Cupping, I’ve heard that done to me before, and that’s where they actually have the flaming cotton ball that’s lit. and when you light that ball and then you put inside of the cup, it create a bunch of suction from the air cooling down and contracting. And so, the idea here is there are variety of muscular skeletal conditions: tendonitis, lack of blood flow, things like that that they try to use cupping for.
But what does the research say? What about the research here on the show. There was one systematic review of cupping done in June 2010. A systematic review of all the different randomized clinical trials out there on cupping. And what that trial reported after they looked at over 921 participants on cupping for everything from hematoma and pain management, and compared it to a conventional drug, and other care. The conclusion was there’s a potential positive short term effect of cupping therapy on reducing pain intensity. So, there’s that if you are in pain in a certain joint, it may temporarily reduce the pain in that joint.
Another clinical research kinda like a literature review also looked into cupping. And this one was done in 2010, looked at 550 different clinical studies. And what they found in that one was not only potential benefits on pain conditions but also on (drumroll please) herpes, coughing, and asthma. So, I’m not quite sure how the cupping for herpes actually goes. I don’t know if you put it over the area where you have a herpes wart or what, but anyways, there’s that.
There’s another update review on the efficacy of cupping therapy in 2012 in which they went through a 135 different research trials on cupping, and they found kinda the same thing that it could be effective for herpes, and possibly for pain management. So, there you go. If you have herpes, or if a joint hurts, it turns out that cupping may actually help you. If you want to win a gold medal in the Olympics swimming the butterfly, there may be better things to do like swim say, or shoot illegal performance enhancing drugs into your right butt check if you are Russian because we all found out that they can do that and still compete, but ultimately, cupping. That’s my take on cupping. I look at the literature and if something hurts, I don’t wanna fix it temporarily and if I come down with herpes, it will be the first place I go.
And then finally, I was asked about this new supplement stack I’ve talked about on Twitter, Facebook a little bit. I’ll be brief here. There was a study in the Journal of Strength Conditioning Research that found 20-25% increases over the course of 12 weeks of training, and we’re talking about strength, power, gain of lean muscle, when people supplemented with 2 different components at the same time. One was called HMB which stands for beta hydroxy beta methylbutyrate which is yes, a much longer word than heirloom, and adenosine triphosphate which you may know better as ATP.
So, HMB and ATP, they took 3 grams of HMB, they took 400 mgs of ATP and they had these huge breakthroughs in lean body mass and strength and power like unfair stuff. This is stuff that just like blows creatine, fish oil, anything out of the water. So, here’s the deal. I talked to my friend Matt from Millennium Sports because I know that he has in his repertoire of supplements both ATP and HMB. I told him if I announce this on the podcast if he could give us all discounts, he said yes and he’s giving us all a 50% discount on this one-two combo of HMB and ATP. I’ve been taking it for about a week and a half, and I feel unstoppable especially when I’m lifting. So, I would recommend you give it a go and at 50% off, you cannot go wrong. Well, you can. You’re still gonna spend money but it’s 50% off. So, how do you get it? You go to bengreenfieldfitness.com/atp, that’s bengreenfieldfitness.com/atp and the special secret code that you use is Ben50. Ben50, so Ben50, you get the HMB and the ATP.
Alright, let’s jump it to today’s show with Dr. Robynne Chutkan on pooping. Enjoy!
In this episode of the Ben Greenfield Fitness Show:
“More importantly, you gotta change what you eat. So, I see a lot of people coming in who want to talk about stool transplant because they’ve struggled way too long, they can’t seem to keep wait off, and it is very clear that this whole calorie-in calorie-out thing, it is severely lacking in terms of explaining lots of things”. “If you take a map at the developing world and you look at it even today, you see in Sub-Saharan Africa and Southeast Asia, there’s very low rates of these autoimmune kind of modern diseases and very high rates in North America, and Western Europe, and so on. And part of this has to do with this hygiene hypothesis.”
He’s an expert in human performance and nutrition, voted America’s top personal trainer and one of the globe’s most influential people in health and fitness. His show provides you with everything you need to optimize physical and mental performance. He is Ben Greenfield. “Power, speed, mobility, balance. Whatever it is for you that’s the natural movement, get out there! When you look at all the studies done… studies that have shown the greatest efficacy…” All the information you need in one place, right here, right now, on the Ben Greenfield Fitness Podcast.
Ben: Hey folks, it’s Ben Greenfield. Everybody knows that I’m a fan of poop. And talking about poop, and so we’re gonna talk about poop and a lot more today because when it comes to healing your gut, or getting rid of bloat and constipation, or changing your gastrointestinal bacteria, a.k.a. your microbiome or really any other digestive topic, my guest today Dr. Robynne Chutkan is probably one of the smartest women and physicians on the face of the planet when it comes to this stuff.
She’s not only on a faculty of Georgetown University and founder of the Digestive Center for Women, but she’s also written not one, not two, but three different books that focus on healing the body from the inside out starting with the gut. And I’ve actually read two of her books: The Microbiome Solution and The Bloat Cure. And yes, she really does love talking about poop. Like in The Microbiome Solution, she gets into the tiny microbes in your gut but also talks about little things that can help to keep you happy and healthy like fixing things like household cleaners and air conditioning for your gut.
And she talks about eating poop (chuckles), we will talk about that today, timing your probiotics, getting a dog to lick your face, eating dirt and a host of interesting things you don’t hear traditional doctors tell you about your gut. And then she also got this other book called The Bloat Cure, and in that book she looks at more of like the science behind what happens when your belly gets bloated, and she gets into everything from not just bad Chinese food but also things like coding and cough syrup, and dehydration and birth control pills, and GMOs, and all these other issues that might be causing you to have embarrassing bloating or gas or constipation, all those other issues that many folks including myself in the past have dealt with but find embarrassing to talk about. She’s not embarrass to talk about ‘em, and so we’re gonna talk about these stuff today. Robynne, welcome to the show.
Robynne: Thank you, Ben. It’s always such a pleasure for me to talk poop with you. So thank you for havin’ me back.
Robynne: I’m ecstatic.
Ben: Well, I have and I guess my first question for you because I’ve got your microbiome solution books sitting here on my desk and in it you talk about how you can actually smell gut issues with your patients. Assuming it’s not because they’ve cropped their pants but there’s something else that you can smell. So, I’m curious about this because I have had conversations in which my face is really close to somebody else’s face, and I wonder because of like this sulfurous almost like halitosis breath type of thing if they have candida or yeast or fungus or something like that. That I can smell something just strange on their breath. What do you mean when you say that you can smell gut issues?
Robynne: You’re right on ‘em here. So, let’s talk about the gut first and then we’ll talk about all the rest of the body odors ‘cause I’m obsessed. I wanna like to start a specialty about body odor and do some research on that, but let’s talk about the gut. So, when I do colonoscopy where I take a long tube with a flexible light on the end and I inserted it to the rectum, and I look up people’s colon looking mostly for inflammation and polyps and cancer. A lot of the patients I see have a type of disease called ulcerative colitis which a type of autoimmune gut disease that causes inflammation in the colon. And I’ve been telling the wonderful nurses in the endoscopy suite at Georgetown where I’ve been doing this for about 19 years that I can tell whether a patient has colitis or just a disease Crohn’s without looking. Now, I actually do look when I’m doing colonoscopy. I can’t do it with my eyes closed, but I’ve been seeing for years that I can smell the inflammation and then the nurses have been saying, “You’re crazy. You’ve done too many colonoscopies”, and then there was actually…
Ben: What do you mean you can… like, okay so, I don’t wanna be too crucial but like when they’ve got their pants down and they’re naked on the colonoscopy table and you’re shovin’ the tube up their butt, are you saying you smell then or you…
Robynne: Ben, I am surely not shoving the tube up there, but I am very strategically and carefully advancing the colonoscope up the colon.
Ben: Yes, that is exactly what I meant.
Robynne: Oh yes, so my point is that you know, we detect inflammation by looking at it so this tube has a fibre optical light source and a very sophisticated camera, and we’re looking at the lining and we’re looking and we’re seeing all sores and redness and other evidence of inflammation. And then of course, we take biopsies and the pathologist looks at it very carefully under the microscope and looks for inflammation, looks for white cells and so on, but my point is that even without looking at it. When I put the scope in, the odor is different and what we realized now, there was a study from Japan looking at gas chromatography and basically the different gases that different bacteria produce, and they were able to identify a signature gas chromatography pattern which basically is a kind of smell when you sort of get right down to it based on the different bacteria presence.
So with patients with crohn’s and ulcerative colitis that have decreased microbial diversity meaning, they have fewer species and strains and they have over representation of some bacteria and under representation of others. And because of this change in a microbiome, the different gases that are produced are different, and when they use this instrument, this gas chromatograph to check the different levels of gases, they could tell, they could predict to have crohn’s and ulcerative colitis and I can predict, well, I mean I’ve never actually done a scientific study, but the point is when I put the scope in and the smell changes, I can smell the difference and even what’s really interesting is even in patients for example who have had trouble as diarrhea were they don’t actually have inflammation, that you can see with the naked eye.
But I will say to the nurses, this person’s colon smells off. I never really like to use the word bad because that’s very subjective, right. I mean, everybody thinks that their poop doesn’t smell bad but it has a very different odor, and healthy stool has one particular odor and unhealthy stool has another, and the same thing. So, when you put the scope up and you’re essentially kind of sniffing the colon if you will, ideally you would not allow the stool in it if the patient has done their job and done the bowel prep but the remnants of the stool are there. But I think what I’m really detecting is a bacterial signature of the stool in different people, and so it was really sort of a treat for me when I saw this article and I kinda come racing into the hospital and I’m like, “look at this! This is what I’ve been telling you all along”.
So we really can, and what you smell in terms of smelling people’s face and so on, the thing with BO is just fascinating. So there are two kinds of sweat glands and Ben, you sweat a lot ‘cause you’re always running around, standing, climbing rope, jumping, so…
Ben: Always. I actually sweat… ever since I started doing a sauna, when people do sauna you actually upregulate a number of capillaries to help you to cool, but you also get more active sweat glands. Like I’ve been doing sauna as a daily or near daily practice for a couple of years, and now like I sweat…
Robynne: You sweat even more.
Ben: … at a drop of a hat. It’s crazy. ‘Cause my sweating mechanism are so good for better or worse.
Robynne: You’re the Ironman of sweat now not just like an Ironman.
So, we have these two different kinds of glands. We have eccrine glands which are kind of all over our body, and they release the typical sweat which is just a little bit of salty water that when it evaporates, it must get to help to cool us, and then we have another kind of gland called apocrine glands and these are kind of in our moist area as in our hairy bits. Like underarm, and our groin, and they release when we’re stressed a milky white substance that doesn’t essentially smell bad, but when it mixes with bacteria in these moist areas, it gives you BO which is why I can go out and run 8 or 9 miles later today in DC where it’s hot, and I’ll come back and I’ll will be sweaty but I will not smell particularly bad but if I know that I have a deadline tomorrow, and I have a document that I’m working on that I’m not finish which is off on the case, and I have to stay up all night, or if I’m about to do like a live TV appearance, and I’ll get that kind of sweaty in the groin and under the arm thing, I’ll be funky. I will smell bad.
I will have BO, and that’s because the difference between the eccrine glands which is just water absorbing from being absorbed from your body and cooling your body down with the evaporation vs. the bacteria acting on these apocrine secretions. And it’s really unbelievable how quickly that can happen if you are in this kind of stress state, fight or flight, and your sympathetic system is firing. Smell under your pits, you’ll noticed a really big difference. So, the whole odor thing, and that’s all bacteria, I mean, funky feet is a different bacteria, it’s all the food that we eat. So, meat eaters, typically smell different from people who are primarily plant-based and you can smell it. As you said, you can smell it on the skin, I see patients who have yeast overgrowth, they have often and you can see the fungal growth in their hairs, it kinda have a red scaly rash in their hairs, and sometimes on their scalp, and you can smell that.
Robynne: You smell it often enough. Yeah.
Ben: It’s crazy. And again, I think our listeners now fully realized that there’s a great deal of talking about stool on the show.
And by the way, the show notes for today are at bengreenfieldfitness.com/bloat, that’s bengreenfieldfitness.com/bloat for those of you who wanna check out Robynne’s books and the other things that we talked about in today’s show.
One thing I’ve even noticed is that since I started doing things like sauna and I do like a metal detox every year, and I don’t really eat processed and commercial foods, at the risk of sounding orthorexic, really almost at all anymore, but not only does my sweat not seem to stink much at all unless I’m stressed out like you just talked about. Like if it’s more like a sympathetic fight and flight type of sweat, but I also have noticed that the bathroom smells different after I finish taking a dump. It smells like vegetables almost or that’s the best way I can describe it vs. like this intense nasty sulfurous smell that you get when you walk in say, like the bathroom at an airport where there’s a whole bunch of people just like pooping toxic crap.
Robynne: Exactly. That they’ve been eating at the airport. (chuckles)
Ben: Yeah, exactly. So you get into obviously how to fix some of those colonic bacterial issues in your book. But also get into some other really interesting things. Some things that we haven’t talked about on the show before for example, one thing is you mentioned both pig whipworms and also hookworms in your book. What the heck that those have to do with your gut and maintaining a healthy gut?
Robynne: So, there’s something called the hygiene hypothesis, Ben, which actually refers to the fact that as countries get more industrialized and more developed, we see higher rates of autoimmune type diseases like MS and asthma, allergies and crohn’s, and ulcerative colitis and so on, and if you take a map of the developing world and you look at it even today, you see in Sub-Saharan Africa and Southeast Asia are very low rates of these autoimmune kind of modern diseases and very high rates in North America and Western Europe and so on, and part of this has to do with this hygiene hypothesis which was described in post-industrial London in the 1950s. They saw skyrocketing rates of eczema and hay fever in kids when everybody had left the farm for the factory. And it refers to the fact that as we become cleaner and too clean one could argue, we kill off all these important sort of founding germs if you will, that are important for training our immune systems so that our immune system doesn’t overreact to bacteria which is really what autoimmune diseases are is an over-reaction of the immune system.
And so, the hygiene hypothesis says that we need exposure to dirt and germs and combination. All these are in fact to develop our immune system. So if we think about our ancestors, they will probably completely infested with parasites, elements like different kinds of worms and so on, and their immune system peacefully co-existed and then in fact this infestation kind of tap their immune system from overreacting.
And so, researchers in the past couple of decades actually have looked at particularly in Crohn’s disease, which again is this autoimmune gut disease, they looked at different ways to dump down the immune system without the risk of infection that drugs dump the immune system like steroids and other immune suppressing drugs. Those drugs can work great for disease like Crohn’s but unfortunately they can also cause severe infection and cancer, and other not so great things. So they looked at this novel-type of therapy of inoculating people with parasites with the fairly being that if you can cause just a limited kind of control to infection with a fairly benign element like worm, you can restore the bodies’ autoimmune system to more balance state, and make it less over reactive.
Now, hookworm therapy is problematic because hookworms can be symptomatic. They can cause anemia, and itching and diarrhea, and infection can sort of get out of control. So, the initial studies are done with hookworm but they’ve also looked at using pig whipworm. The advantage of that is that the whipworms cannot multiply inside the human host. So, you give a small inoculum and see how people do, and then once you think they’ve died off, you give some more as opposed to the hookworm which can reproduce within the body. And there’s been some good trials.
One trial with about 50 people with ulcerative colitis, they looked at giving sort of re-administering the eggs every few weeks and after 6 months of therapy, 80% of the patients had significantly reduced disease activity, and almost 3 quarters of them had gotten to complete remission. So again, I don’t wanna suggest to people that they go out and they infect themselves, but from a theoretical point of view, this is fascinating and we are not quite there. I am not using hookworm or pig whipworm therapy in my office. I’m doing mostly nutritional therapy for these diseases, but we are definitely on to something here with this idea that we have become too clean and we need our microbiome in order to restore our immune system, our overall body into a more balance state of health. We need to really re-think our relationship with nature, and with bacteria and viruses and worms and all these other things, and this sort of mischaracterization of all drugs as being bad has made us pretty sick.
Ben: Yeah. That’s fascinating and when it comes to like hookworms and pig whipworms, correct me if I’m wrong here, but the idea here is if you have gut inflammation or some kind of like, we’ve talked about autoimmune issues on the show before like people who perhaps are really sensitive to wheat or milk or eggs or something like that and then eating them for a long periods of time. So they’ve got infection or not really infection but more like inflammation or leaky gut or something like that, when you eat the eggs of a pig whipworm or a hookworm or something like that, what you’re essentially doing is shutting down that inflammatory response by triggering some kind of an immune response against that whipworm or that hookworm?
Robynne: Yeah. You know, what it is is that when your body is dealing with chronic, let’s not say infection but say co-existence with something like a whipworm or a hookworm, it realizes after a while like – “okay, I don’t have to sort of mount to big reaction to this. There’s this worm living with me and we’re gonna figure out a way to get along. Kinda peaceful co-existence. And so, I’m not gonna freak out.” And so, the idea is then it dampens your immune system down so that it doesn’t freak out in other ways. So with diseases like Crohn’s which mostly involved in overreaction to the body’s own gut flora, the body’s own bacteria that it will take that same kind of chill attitude and say – “oh, I’m not gonna overreact to the bacteria and the gut either and cause ulceration and strictures and bleeding.’ So it kind of dampens down the immune system in general but not in a pharmaceutical way where you increase the risk for overwhelming infections.
Ben: That’s interesting. So for something like pig whipworm therapy for somebody who has severe gut issues or an autoimmune disease, or something like that because the eggs can’t multiply. This is just like a treatment that you take every few weeks?
Robynne: Exactly. As this can multiply and then you could actually end up with quite severe hookworm infection if you’re not careful. But you know, this idea to going back to early childhood, so we’ve always been a little bit into the benign neglect form of parenting where we don’t get too disturbed if like when our daughter’s eleven but if she eat something off the floor, it was like – okay, that’s fine. It doesn’t look hideously dirty. And it turns out that that is actually really an important thing, and this whole hygiene hypothesis when David Strachan who was this professor of Tropical Medicine at the London School of Hygiene was tasked with figuring out why they were seeing this skyrocketing rates of eczema and hay fever in post-industrial London.
He made two really important observations that formed the background and the backbone for the hygiene hypothesis. The first is that kids who came from large families had very low rates of hay fever and eczema. Why? Because they had a tiny siblings who were sneezing on them, coughing on them, giving them measles, mumps, whatever, making them sick. And those illnesses which were kind of low risk illnesses that one thing people are dying from were strengthening their immune system.
And the other startling observation was that kids who came from affluent families that had higher levels of hygiene. I mean again, this is like 1950s in London. So, this is like a household of 10 people with 1 bathroom. So, people who are in more affluent households who had better access to more hygienic practices had higher rates of hay fever and eczema. So it was good to have lots of siblings and it was good to be relatively poor in terms of your immune system back then. And we still see this trance today and so we still see that these kids have higher rates allergies and asthma.
Ben: Right, yeah. It’s something that we’ve certainly talked about a little bit on the show before and that you touched in the book like everything from getting out and gardening, and even like licking the dirt off your hands which sounds nasty but there’s actually something to it to letting your dog lick your face and not being afraid of the germs that you might get exposed to from your pet. And even me honestly, Robynne, I used to be a little bit of a germ freak especially when I travel, and I would do things like really high dose of oil of oregano and thieves essential oil, and all these different things when I was in crowded places and buses and airports, and I quit doing that for a little while just to test this idea that perhaps I do just need to make sure that I got expose to wide variety of germs and bacteria.
And frankly, unless there’s some kind of issue going around like bird flu or unless I know, or swine flu or unless I know that I am literally sitting next to a kid that has the sniffles who just cough all over the place, I’ve been a little more reticent to be so much of a germ freak. I still of course wash my hands when I go to the bathroom at an airport or something like that but yeah, it’s been less and less of a concern for me these days.
But you also get into your book, you kinda go above and beyond just like pig whipworms and hookworms, and you talked about this Bedouin tribe that actually eats camel feces, and you also pointed out about how we have all these other animals in nature that will eat each other and other animals stool. I’m curious at how what this is have to do with the gut in terms of something like the Bedouin tribe eating camel feces because I was always on the impression that you really increase your risk of getting exposed to things like giardia, or amoeba or nasty things when you begin eating the poop of some other creatures. So can you kinda delve into this for us?
Robynne: I sure can. So let’s be clear though. You’re only as healthy as the stool you’re eating. (laughs) But I’ll just start it off with that. So, this concept of coprophagia, of eating stool is not new. It start…
Ben: What’d you call it? Coprophagia?
Robynne: Coprophagia. Right. So we think of it more like, you know, there’s different forms of, I don’t know how to put this diplomatically, but there’s a term for it called scat sex, scatological sex that involves different sex acts and then involve eating stools. I’m not talking about that or I’m not talking about people who are mentally ill and sometimes in just to, I’m talking about this from a more sort of medical point of view.
Ben: Right. We’ll say the ki-ki stuff for another show.
Robynne: Will say that for another show. I’m not sure I’m quite qualified to be on that show. (laughs) I’m happy to say. But we’ve known historically that certain Bedouin tribes would eat camel feces when they have dysentery. So when they get a very bad diarrhea and vomiting, and clearly have something infectious, that they would eat small amounts of camel feces from healthy camels, and that’s to reintroduce healthy gut bacteria, and veterinarians have done this for decades that if there is diarrheal type of illness in the herd, they’ll take stool from healthy cow and they’ll give it to the other cows to eat. And it’s basically just sort of nature’s probiotic, right? So when we’re talking about cows eating other cow poop or the bad one eating a little bit of camel feces from animals that have been under their control and that they’re very aware of their health, that’s different from people just going in sort of randomly having someone stool.
But we’re in this era of FMT, Fecal Mirobiota Transplantation as a technical term, and it is turned out to be this unbelievable cure for a very difficult problem that we’re seeing with the rising incidents in the United States and that’s clostridium difficile infection. So clostridium difficile or C. diff as we like to call it, is a very hearty bacteria that a lot of us are colonized with at birth. If you’re born in a hospital, 3 or 4% of us are colonized with it. But people get it after taking antibiotics because it kills off so much of the healthy bacteria that small levels of C. diff can proliferate, or if you’ve been on antibiotic recently and then within the hospital setting where there’s plenty of C. diff, the C. diff now proliferates out of control because all of the healthy kind of gatekeeper bacteria that would normally keep things suppressed are not around, the C. diff proliferates and has been very resistant to antibiotics.
A few years ago about 4 or 5 years ago now, an article is published in the New England Journal of Medicine which is a sort of gold standard medical journal about FMT fecal transplant as an alternative to antibiotic therapy, and in fact in the seminal study the FMT was so successful. They had to stop the study and they said ethically they cannot even continue to use antibiotics for these refractory cases. Not as for first line therapy, then people would refract C. diff and C. diff kills about 15 or 20,000 people in US every year.
Ben: How do you know if you had the C. diff?
Robynne: Well, if you were having what we call a piece soup diarrhea, watery, severe diarrhea and you’ve been on antibiotic recently like in the last month or two before it developed, it is absolutely essential that you get a stool test for C. diff. There’s a toxin that it makes and the stool test is very easy to do and all the commercial labs do it.
Ben: Will this be like a poop panel like the 3 day gut test where you just like poop (chuckles) in a hotdog tray for a few days and…
Robynne: No, it’s a little bit different. No, it’s just a one-time specimen actually that you can send. I mean, if we have a high index suspicion, we actually like to get 3 samples because the sensitivity really increases with 3 samples, but it’s just a small specimen and then they run it in the lab and they run it pretty quickly. They can get a result back in 24 hours. The C. diff talks, and once we identify that, so the mainstay of therapy for C. diff had been antibiotics primarily one called metronidazole and another one called vancomycin.
But when you think about it, what causes C. diff? C. diff is cause by antibiotic use. So it kind of make sense that giving more antibiotic is not necessarily the best way to treat it, and that’s exactly what we’ve seen. We’ve seen a ton of refractory C. diff and not responsive to those antibiotic. So FMT is something that people started using, and it is now the goal standard for refractory C. diff. But as you can imagine, Ben, there are lots of problems with ingesting. It’s usually done at colonoscopy given through the rectum, we can do what is capsules that people ingest, we can drop NG tubes which is the gastric tube down to the stomach and give the stool that way. There are lots of ways to do.
Ben: And you obviously not using that person’s own stool. You’re using the stool from someone else.
Robynne: From a healthy person. Either a healthy relative or friend sort of intimate contact is ideal. There are stool banks now. There’s one called Open Biome based in Boston where they provide, they do very extensive testing and screening of the stool, and they have robust donors who have healthy stool, and we get frozen stool from them and we thaw it out and we use it. And so, a lot of hospitals we use Open Biome at Georgetown doing that if somebody doesn’t have a good donor because as you pointed out when we started talking about this, it’s not all fun and games in terms of stool transplant because stool is also a waste matter and it contains toxins and it can contain infectious things.
So we have to test for psifillis and HIV and hepatitis, and a lot of things in the donor stool and you’re getting not just the good healthy microbes in the stool, you also potentially getting DNA from not so good microbes and viruses, and any infectious things and there’s a lot that we can test for and in my book, I have a whole section on everything you wanted to know about stool transplants or you are free to ask including all the testing that we do.
And it’s a lot but there’s also lots of things we can’t test for because we don’t know about them yet. We don’t know how to test for them and so, the things that can be spread through stool, you can spread C. diff, you can spread crypto, E-coli, giardias, (you mentioned) hepatitis, neuro-virus, poliomyelitis, rotavirus, shigella, tapeworms, typhoid fever, vibrio, lots of things. But the real list is probably 3 or 4 times as long with the things that we haven’t even discovered yet, and we can’t test for.
And so, a couple of things with stool transplant like, you have to make sure if you’re doing it, you’re getting it done for something whether it’s actually been a clinical trial showing it works, so that there’s some risk benefit calculation that’s going on. So, if you have refractory C. diff and you’ve been treated with a couple of antibiotics and you’re not getting better, you’re probably a great candidate for fecal transplant and probably just one stool transplant is gonna fix your problem.
Robynne: If you have a condition like Crohn’s or ulcerative colitis or some forms of irritable bowel syndrome, there’s some clinical trials but you should be doing this in the setting of a clinical trial where they are actually looking at this parameters and so on. And again, there’s a lot of optimism and there’s a lot of hopeful data but it’s important for people to remember that for some of these autoimmune diseases, it’s not a one shot deal like the C. diff, you have to probably be doing stool transplant a couple of times a week for several months maybe, even years, maybe even lifelong trying to reverse the damage. So those are situations where you’re dealing with much more microbial discord than just overgrowth of one troublesome bacteria, you’re dealing with people who have a genetic predisposition for these diseases and have significant changes in their microbiome that you’re trying to undo.
I spend more time in my office talking out of stool transplants than convincing them that they need one because people feel like – oh, this is a fantasy, right? I have microbial discord and that’s why I’m fatigue and my hair is falling out, and I’m bloated and I don’t feel good, and it may be but we don’t have evidence that doing a stool transplant is going to fix those things.
Ben: Right. So, this would be not for people who just like have a tummy ache or who are constipated every once in a while.
Robynne: Fairly not.
Ben: This should be for someone who has like C. difficile, they’ve been tested, they get diarrhea a lot, but about like irritable bowel syndrome? Irritable bowel where you just like really touchy gut, you have gut issues, is this something that is worth I guess trying or will this really be last resort for C. difficile, my butt is exploding with diarrhea type of thing?
Robynne: It can. There’s a lot of really interesting data that show 4 people who have what we called diarrhea predominant IBS, IBSD that in a lot of those people there is some infectious antecedent event that kind of creates the damage. And so there’s studies that show in a sub-set of these people with IBS, they actually can have significant improvement. But again, it really needs to be in the setting of a study where they’re looking at your disease and they’re seeing if you’re on this diarrhea predominant sub-tight and you meet the criteria, and so on. And the results are definitely not as dramatic as for C. diff, there’s a small study from New York, from Montefiore Medical Center, and I think the FMT result were improved symptoms in about 70% of patient with a refractory IBS and improved quality of life in almost half but again, you have to carefully and you wanna make sure that your IBS is not because you’re gluten sensitive and didn’t realized it or you’re lactose intolerance.
That’s why it’s so important to do this in a center where they’re gonna carefully exclude other causes and not just say, sure I can stick some stool up there for you. I mean, unfortunately there are lots of clinics that do that. They charge a ton and they’re treating many, many different groups of patients, some who probably have a qualification but many who don’t, and are just kinda desperate and we all know, I mean, we’ve all been there probably in one form or another or where you’re desperate about something and you literally are willing to try anything.
After I had my daughter, she’s 11 and a half now, I had a lot of hair loss and sort of typical what they called the postpartum hair loss, a [44:44.8] ______ that develops, and I was desperate and I was trolling the aisles of the health foods store late at night looking for some miracle thing and I remember my husband saying to me who’s bald and shaves his head, and he was like – “honey, if that’s stuff work then have an afro, right?” So… (laughs)
Ben: That’s funny.
Robynne: I think you just have to give it a little bit of time. But I understand I mean, even with a medical background I was still like – oh, if I take enough biotin and iron or whatever, maybe I can make this comeback and hormonally things kind of settle down, and it was all fine but completely understand. And there’s so much we don’t know in Medicine. Convention medicine is lacking in so many ways and so it’s very, very kind of intoxicating to think about the idea that gosh, my microbiome… you know, I took a lot of antibiotics when I was young, I’ve been on steroids or acid suppressing drugs or antacids or other things that messed with my microbiome, and that’s probably why my hair is thinning, and I’m bloated and I feel tired.
And again, that may all be the case but what we have to look is the flipside of that is ingesting your friend’s stool, your husband’s stool, your girlfriend’s stool is that kinda make you better, we don’t know. I mean, most people who were born and raised in America have probably kind of had similar experiences with being over-medicated and undernourished, and so, what I would say to most people, if you kinda do that, you should be getting stool from the Hazda Tribe in Tanzania or Amazonian brothers and sisters. Because if you’re ingesting someone’s stool who’s been taking antibiotics and eating crappy food, it’s not gonna do you much good.
Ben: Yeah, you want a stool of someone who poops like a baby. Now, that actually leads me to two other quick questions that I have for you about fecal transplants, and I promise for those of you listening in where I can type and eating poop the whole time, but you talked about like getting the of poop of Hazda hunter-gatherer tribe, and then one of my buddies, Jeff Leach, he actually did that and he hung himself upside down and…
Robynne: He’s terrific. I follow him. He’s fantastic. Yeah.
Ben: But my question about that is does it change? Like we all know that the gut helps to create neurotransmitters, it has a great deal to do like if you don’t have enough bacteria, you can get depressed. They’ve shown that probiotics can now be used as an anti- depression treatment, but my question is if you get a poop transplant or have you seen this in your clinic, do people’s personalities change like take on the characteristics of the person who just poop has been transplanted into your, like if you get a Hazda injected, you’ve become like a mighty warrior. Well, what happens?
Robynne: Well, most of the experiments we have is in people who are getting one stool transplant for C. diff, so things are not changing dramatically, but we did have a patient who received a donor stool from her daughter who was obese and she started to gain weight, and that’s something we can chat about in a minute. But just to get back to how things change, we think that stool from again hunter-gatherers that have been eating a McDonald’s and taking antibiotics is better, and it probably is but there is also adaptation. So you want stool that’s adapted for your particular environment.
We know that there this different enterotypes in terms of how we classify the ecosystem in the gut and it’s a way we kind of strategize people based on the representation of different species. So about 5 or 6 year ago, we came up with this classification of different enterotypes, so type 1 has high levels of family bacteria called bacteroidetes and then type 2 has low bacteroidetes but lots of prevotella, and type 3 has high levels of [48:31] ______ different families. And different entrotypes don’t seem to be influenced much by age, gender where you come from but they are very much affected by long term diet.
So if you are one enterotype in North America and you’re getting stool from another entrotype from somebody in sub-Saharan Africa, you probably not gonna see long lasting change in your microbiome because your microbiome is more defined by what you’ve been eating your whole life and by this one sort of introduction of stool. So it’s not enough and then this gets back to the issues of, for autoimmune diseases where we’re really trying to create meaning change. It’s gotta be on a regular basis and more importantly, you gotta change what you eat. So, I see a lot of people coming in who wanna talk about stool transplant because of struggled way too long. They can’t seem to keep their weight off, and it is very clear that this whole calorie in and calorie out thing is severely lacking in terms of explaining lots of things.
So, I see and you Ben, I’m sure you do too who are eating a very calorie restricted diet and are not losing weight. So it’s more than just a calories in the food, and it’s more than even the percent of protein, fat, carbohydrate. Different people metabolize differently and we know that a lot of that is a microbiome. So microbes can actually do unbelievable things in the gut, Ben. They can change the taste buds, they can make certain foods taste better like sweet vs. savory, they can affect the transit time, so they can speed up the transit time through the gut, so fewer calories are absorbed or they can slow it down. They can themselves ingest and digest extra calories so that fewer stirred by fat, so microbes can really change what we called the energy harvest of food. And we see it all the time where people are very calorie restricted, they’re still not losing weight. Other people eat a ton of food, they don’t exercise that much, they don’t seem to have as much problems.
We know there’s one particular bacteria called [50:30.1] ______, you can say it 3 times fast, and that [50:35.2] ______ seem to be associated with leanness and there seems to be a genetic inheritance pattern and we’ve all seen families where like everybody is a string bean, right. It’s this families where like it’s all ectoderm and they just never, everybody’s tall and skinny like a beanpole and never gains weight. And so, there are some of these genetic tendencies. So there’s been some really fascinating studies where they’ve taken microbes from obese mice and transplanted them to germ-free mice, and the germ-free mice start to gain weight without any change in the diet. And they’ve even done it from humans to mice.
Researchers at Washu took identical twins where one was lean and other was obese, same genetic material transplanted the microbes into germ-free mice, and lo and behold, the mouse who received the microbes from the obese twin gained weight without any change in diet. So we know even in a cross species this occurs, but at the end of the day, it’s still about what you eat because I can give you billions of microbes from somebody really lean unless you’re eating the right diet to nourish microbes, they’re not gonna recolonize, they’re not gonna repopulate your gut, and they’re not gonna have a lasting effect on your microbiome.
So this idea that all the pharmaceutical companies are kind of racing to come up with the microbial cure for obesity, there are probably different microbial strains, probiotics that people will be able to ingest that will help, but at the end of the day, it’s still boils down to you gotta eat more vegetables because there’s nothing you can take and then you can eat Doritos and drink soda and lose weight. It’s just doesn’t exist and it’s not going to.
Ben: Right. You mean dirty vegetables especially.
Robynne: Eat dirty vegetables.
Ben: That’s my big thing. I’ll take them dirty as I get them from my garden and not wash ‘em. And obviously if you’re buying your vegetables which are not organic and from the grocery store, freaking wash them so you’re not getting glyphosates, and herbicides and pesticides into your system but yeah, vegetables plus dirt is a pretty good scenario for people’s gut.
One last thing on poop pills and then I want to talk about constipation a little bit. Poop pills from what I understand based on the most recent news do not work compared to the actual I guess that you would call it ‘poop up the butt’ type of scenario like the fecal transplant. It looks like there are a couple of pharmaceutical companies trying to develop a drug, and I know Buzz Feed just had an article about this, and they spend all this money developing this microbial transplant stool sample pills and apparently it didn’t really show much efficacy at all in this study on oral consumption of a poop pill. Do you know anything about that?
Robynne: I do. So there are 2 different things that we can talk about here. One is actually a Canadian study that took stool from a healthy donor and encapsulated it, and it was about 37 different pills you had to swallow of the actual stool. And that study and a couple others like ‘em that have taken actual stool and just put it in like a little liner to protect from the acid in the stomach and have you swallow them, those worked and those seem to work as well as the stool up the butt. If it’s actual stool, you’re talking about is probably series of the company that had these spores that they were using these bacterial spores that you would ingest for C. diff, yeah, and their data was very surprising to all of us ‘cause their primary data was very promising. They did not work for the C. diff, and they’re kinda going back to the drawing board but that’s different ‘cause that was an actual stool. Those were bacterial spores because nobody ingesting someone else’s even you know, my husband, I love them, I still don’t wanna eat his stool. It’s still not, it’s sort of hmmmm, so they’re really looking at different things that they can do. So for example, Ben, if you’ve got C. Diff could they take your stool and pull out the healthy strains and amplify them outside of your body, and then give them back to you. Sounds like a great idea, right?
Robynne: Or your own stool but just taking out the good stuff and really amplifying it, can they do that? Could they take again just the spores, could they take healthy bacteria and amplify them without all the other yuck stuff from the stool. They haven’t really been able to do that well yet, but that’s definitely the goal is to able to not give the whole stool for a couple of reasons, the yuck factor as well as the fact that you’re transmitting toxins with the stool too potentially.
Ben: Interesting, okay. If you’re listening in, don’t go rush out and buy poop pills ‘cause they haven’t really been shown to work.
Robynne: Go get some dirty vegetables ‘cause those actually work.
Ben: Alright. Let’s talk constipation. I think we’ve kicked the FMT thing to death. At least a little bit. You’ve an entire chapter in your book, The Microbiome Solution that actually goes into like you mentioned, everything you’ll always wanted to know but were afraid to ask about fecal microbiota transplant.
Okay, so how about this, constipation. I know a lot of people have constipation ‘cause I get questions about it all the time. I don’t know if it’s because a lot of active people listening to the show who eat copious amounts of food and who are also type A personalities, I don’t know if it’s because of some of the issues that you talked about in Bloat Cure but there are a few things that I kinda folded over as far as pages in the Bloat Cure. And possible causes of constipation that I hadn’t seen talked about too much. One was musculoskeletal imbalances like pelvic floor disorders and something called anismus.
And the reason that I wanted to ask you about this was because I have noticed that if I am competing, lifting, et cetera, for long periods of time without deep tissue work, and specifically without doing things like, yoga tune up balls and roll all those tight areas in the butt checks around on the yoga tune up balls, and I will use this car buffer-type of massage device that kind of like rumbles just like a vibrator, and I will work the front of my abs in that like deep tissue areas in my abs that just like any other area of the body from doing a bunch of abdominal work tend to get really tight and adhesed, and you talked in your book about pelvic floor disorders and musculoskeletal issues related to constipation, I found that if I let all that stuff get tight, I don’t poop well even if I eat a healthy diet. So, can you get into this idea behind as what you call, do you pronounce it anismus?
Robynne: Anismus, yeah. So constipation is actually one of my favorite things to treat because we have a very high success rate, and this is where I get to be a little bit of a medical detective and roll my sleeves up and start snooping around. So, we remember that the GI tract is just one long muscle and it’s not that different from your biceps or your hamstring or your any other large muscle in the body, animus got some specialize features to it but if you’re not moving, neither are your bowels because you’ve kinda have to work them out and that doesn’t necessarily mean doing an Ironman, it could be walking around the block, it could be standing like as I talk to you now ‘cause I know you’re standing, Ben.
So, if you’re really sedentary and you’re sitting for long periods of time, chances are you’re gonna have sluggish bowels and the most sluggish bowels we see are people in nursing homes that are literally lying on their back for 20 to 23 hours a day. But when you think about it, sitting is definitely the new smoking and many of us who are younger and not nursing home candidates are having that experience. We’re sitting in chairs and doing nothing for hours and hours during the day and then we’re kind of jumping up and like – oh, let’s go to soul cycle for 45 minutes and unfortunately that’s not enough a lot of the time. It’s really that sort of daily, hourly ‘what are you doing’.
So, number one, it’s a muscle and it needs to be exercised. Let’s talk a little more specifically about anismus. Anismus refers to essentially when you sit down or squat or how you’re having your bowel movement to try and push the stool out. There’s a muscle that has to open this pelvic talus muscle angle has to change and allow the stool to clump.
Ben: Oh yeah. You’ve talked about that before when we’ve talked about squatting to poop in the squatty potty.
Robynne: Yes! Love the squatty potties. So, or I’m pretty bending here like both, so I just put my heels up on the toilet sit and every now and again I tip over but unfortunately, it doesn’t happen too often. (laughs)
Ben: That’s what I do when I’m traveling actually ‘cause I do not travel with a full squatty potty. (chuckles)
Robynne: (laughs) You don’t? You don’t have it on your backpack?
Ben: No. I don’t think they make one.
Robynne: Shame on you. So, with anismus what happens is that that angle doesn’t open to allow the stool to come out in there. The number of reasons that why that can happen in women it’s often something that happens from the time they’re young girls. Girls in general tend to be more fastidious about the bathroom facilities. So girls,
I mean, this is a huge generalization but girls in school will be like – oh, there’s a gap in the door and somebody can see through or people could hear, or it was dirty, and we tend to be become more aware of our surroundings like bathroom surroundings and so on, and be more embarrass by that at a younger age, and then boys. Girls often develop this whole concept of shy bowel where, oh they don’t use the bathroom at school, they have to wait ‘till they get home, or if they’re traveling, they don’t wanna go on an airport.
It can happen to men too obviously. But what that does is it totally confuses your bowel. So now you get that urge to go, the stool is all lined up in the rectal vault ready to come out, and instead of you sitting down and opening of that angle by the most relaxing, instead you’re squeezing and you’re again confusing the bowels. And they’re like – oh, well I thought it was supposed to open and I guess I supposed to close and hold it in. And if you’ve ever had that experience where you have to go and then you’re like – ahhh, I’m gonna do something and come back. Often it’s gone, right? You’re done for the day. It’s just not coming back. And it’s because you’ve confused the bowels, so it’s so important that there’s such exquisite feedback with the enteric nervous system and the gut and your brain. And so, you have to be so careful that you’re not un-training your bowels and that’s what happens to so many people like – oh, I’m not gonna use the bathroom at school, I’m not going to have bowel movement at work, I’m not gonna go on the train, which can be challenging. And then, lo and behold when you’re finally ready, you’re bowel is like – oh no, you tell me to hold it. So I’m holding it and I’m not letting it go. And so we have to think about that too.
Well, there’s this woman who has a pelvic floor that descends as it, you know, everything kind of eventually descends and gravity takes over but particularly if you had kids, there’s something called rectocele which can be a big bulge between sort of GI tract and the vaginal vault, and still can get stuck in there. Sometime women have to kind of put a finger in the perineum, in that space between the vagina and the rectum to press some things to get that pouch to empty. The muscles can do the whole relationships between the muscle changes. So, pelvic floor problems, anismus which can develop from holding.
In kids what can happen a lot is let’s say, you’re out, you’re kids are at summer camp and they’re not drinking enough water, and they’re not eating lots of fruits and vegetables, they get a little constipated, then they find that when they finally pushes the stool, that they might get a fissure or a little tear in the lining because the stool is really hard. And then because of that fissure every time they go, they have pain. So what do they do, they start holding it and we have kids coming through all the time in the emergency room who are impacted there literally, full of stool because they got a little fissure, it got painful and then they were like – oh, I’m not pushing this out. It hurts too much. And it happens with adults too. So it’s so important to really have a dialogue with your bowels and to make sure that you’re doing all the right things. I mean, things we know about like fiber and water, but also the movement, not holding it, hitting that signal when it comes is super important.
Ben: Now, one of the other things that you talked about when it comes to constipation is this idea of dysmotility which I guess is like a sluggish bowel, is that pretty common and if so, are there things that you can do? Like I’ve heard of prokinetics for example, like special capsules that have ginger and stuff in it that speed up the bowel function. Is that how you fix something like this? What’s the deal with colonic dysmotility?
Robynne: So colonic dysmotility is very much a real phenomena and unfortunately the causes often found in the medicine cabinet. So, anti-depressant, narcotics are number one on the list, so pain medications definitely slow down the bowel, and so much so that there’s a whole term for it. Now, opioid induced constipation and unfortunately a drug for it instead of like – oh, get out the opioids…
Ben: That would be stuff like valium or ambien or stuff like that?
Robynne: Oh, it would be more things like Percocet or Demerol, and things like that. So, opioid containing narcotics which are so over prescribed in the US, and there are people who have real pain and who need real drugs but so often it’s somebody’s got in with something minor, a little muscle ache, and then we tend up prescribing them a serious narcotic, and not only does that potentially the problems with the addiction and dependence but it leads to serious bowel problems ‘cause it slows the bowel down. So we see lots of people who are really constipated because of pain medication.
Ben: So it’s not medications that would make you tired specifically opiates or opioids?
Robynne: Well those are probably the most egregious in terms of having the most significant effect on the bowel but lots of the over-the-counter medications can do it too. They can dry you out, like anti-histamines can do it, anti-hypertensive medications can do it, calcium can do it, iron supplements can do it. There’s so many things that can cause minor constipation and then if you add to that a little bit of dehydration, a little bit of inactivity can lead to more severe dysmotility, but I really recommend the first thing you do is you look in your medicine cabinet, and you really investigate the effects on the bowel of drugs that you’re taking like prescription drugs, over-the-counter drugs, supplements that you’re taking. That’s number 1.
And then, there are prescription prokinetic drugs on the market but they’re not great. Most of them cross the blood brain barrier and have neurological side effects, so you kind of swapping one problem for another which is not so good, or they have other issues as one that can cause prolactin release and can cause you to start releasing milk from your nipples. Not so great if you’re not nursing. So they all have potential side effects that can be problematic. There are some natural things that you mentioned that can help, but again, water, movement, more fiber, natural kind of pro-motility things that you can do.
An abdominal massage can help a lot. In my first book, “Gutbliss”, I have this whole section on happy abs on how you can use light weight or even just your fist and move it in a clockwise direction kind of circumnavigating your belly button to kind of help move the products of digestion through your GI tract. Twisting yoga poses are great…
Ben: I swear by that. Like, it’s really interesting you bring this stuff up because I actually have a special morning routine where I do some torso twist, and what are called these core foundation poses which actually kind of elongate a lot of the organs and the gut, and then I do that massage on the abdominals. I have a whole system done.
I know were getting close to the end of the podcast and so, I wanted to rapid fire a few questions at you regarding the gut and some of the other things that you talked about in the book. So we might go with faster answers to these questions as we delve into rapid fire. But here is a quick overview of what I do to poop like a baby, and you tell me what do you think of this.
Ben: Okay. So, the night before I always take a little bit of magnesium and water but then I do like a, I don’t know if this would be considered a prokinetic or what, but I do a blend of turkey rhubarb root and slippery elm bark and marshmallow root, fennel seed, fenugreek, in this stuff called Nature Cleanse.
Ben: I do that with a big glass of water and some magnesium. That’s the night before.
Robynne: Love it. Magnesium is a really great gentle helper for constipation. So love it.
Ben: Yeah. Magnesium seems to help when I combine it with this Nature Cleanse stuff. It’s like a pawn one-two combo. And then what I’ll do is I’ll get up in the morning and I have another big glass of water and I have a cup of coffee, and do those foundation poses to decompress the spine and open up the organs and then I finish with that left to right massage for about 5 minutes, then again the squatty potty and everything just like falls out.
Robynne: I love it but…
Ben: Good protocol, bad protocol, am I missing anything?
Robynne: Great protocol but I think the part that you should mention is that you also eat a diet with lots of plants. So…
Ben: I do.
Robynne: That’s great. So that is not gonna work so well if it’s Doritos and soda all day long. I mean, it help a little bit that you squeeze out of small hard Western stool but…
Ben: And then as we know from earlier, it’s still gonna stink like Hell.
Robynne: (laughs) But it’s not gonna smell off.
Ben: Okay. Alright. So, my Ben Greenfield pooping routine is Robynne checked and approved.
Robynne: Okay. Come and hang a shingle with me. I could use your help actually.
Ben: Okay, cool. Number 2 – alcohol. Good or bad especially like a nightly glass of wine which I know a lot of people including myself do. God or bad for the microbiome?
Robynne: In moderation is neutral. So alcohol is metabolized to acetaldehyde which is kind of a first or second cousin of formaldehyde. It’s a toxin in significant amounts but you can get away with a glass of wine. Most people can, it kinda depends on what else is going on, what kind of shape your liver is in, what the rest of your diet looks like, but for most people a glass of wine can be neutral. It’s when you get into higher amounts or again if you have any of these underlying problems. But remember that before there was penicillin what was remain antiseptic, it was alcohol, right? That was they use to clean the operating rooms and wipe stuff down. Even now when you get to get your blood drawn, that’s an alcohol swab that they use to clean the skin. So, alcohol does kill microbes in concentrated amounts and then in various forms, so you do have to watch the intake.
Ben: I know it also increases gut permeability. So being super stressed out like at the end of the day when your gut permeability is already gonna go out from that, and then like maybe doing a hard exercise session that blow out some steam, and have some alcohol to wine down, I know that that’s actually pretty bad for the gut. So using alcohol if you are already stressed can increase gut permeability. Is that correct?
Robynne: That’s true and actually what you said about intense exercise, we do this intestinal permeability testing in our practice where we use a small sugar and a large sugar, mix them together and we measure it in the urine. An intense exercise can definitely increase intestinal permeability, so as you mentioned that order in which you do things is really important here.
Ben: So that’s why many athletes have leaky gut. So, at the end of a hard day like that, smoke a joint, don’t drink a glass of alcohol. (laughs)
Ben: Okay so, you hear the rabbit fire questions. Probiotics and antibiotics. A lot of people take probiotics when they’re taking antibiotics to make sure that they just don’t completely lose all their gut bacteria, you talk a little bit in your book though about how the timing of this strategy is important. Can you get into that a little bit?
Robynne: The timing is important but it’s also magical thinking to believe that a probiotic is completely mitigating the damage and antibiotic is doing 5 days of a typical broad spectrum antibiotic will remove a third of your gut bacteria. And it can take years to come back and when it does it typically comes back in a very patchy way. You’re going to be missing microbes.
There is no probiotic on the planet, not now, not in the future that is going to change that. So, you have to embrace the fact that you are doing damage to your microbiome that cannot be reversed with the probiotic. And so, my first piece of advice is be very judicious in taking the antibiotics. Make sure that there is no other way you can fix this problem other than an antibiotic. And then when you are taking a probiotic, make sure it’s the most robust one. You can get your hands on but it has enough colony forming units that it has the right strains, that it has the right mix ‘cause the bacterial competing for the same resources. Make sure that the viability of strains has been verified but understand that this is not somehow like – oh, I take an antibiotic and I pop a probiotic and all is well.
In the book I described an antibiotic is taking a bath full of water and draining out all the water, and then taking a probiotic is pouring a cupful of water back in, and that’s probably about right in terms of the equations. So, strict avoidance of antibiotics unless absolutely necessary is still a sort of number one, two and three thing to do if you have to take an antibiotic, then there’s a whole chapter in the book about choosing a probiotic and the timing is important, Ben, as you say.
So you wanna take the probiotic as far away from the antibiotic as possible. So if you consider most antibiotics are gonna be twice a day, let’s say you’re taking it 8AM and 8PM, then you wanna take the probiotic at about 2 o’clock kind of right in the middle of those doses. And you wanna take it during the antibiotic use and then after probably for at least a month then maybe at a double dosage depending on what the antibiotic you’ve been on is.
Ben: Okay. So you take the probiotic at a separate time as the antibiotic like a 2PM if you’re taking the antibiotic at 8AM, and at 8PM and then honestly like, folks if you’re listening in and you’re on antibiotics and you are plan on being, go into this book, The Bloat Cure, and I’ll link to that in the show notes over at bengreenfieldfitness.com/bloat because Robynne goes into everything from how you should be eating prebiotic foods to using shataki and mitake mushroom extracts, to using bentonite clay, drinking ginger tea. She’s got a whole bunch of things that you can do to basically limit the damage of antibiotics. I love that part of the book. So be sure and read that section if you would like, it’s one of those things that I circle and underline.
Those of you who follow me on snapchat knows that I’m constantly posting underlined sections of books that I read to snapchat, and this is definitely one of those section I had underlined and taken some photos of. So, I’d probably get sued by your publisher but it disappeared within 24 hours, so…
Okay. Last question that I have for you. Just a little fun one here. So, I’m not Paleo, I eat beans, I eat legumes. I don’t eat a lot of them but I do include them like I’m not anti-bean like I do natto, and I do lentils now and again. You have a really interesting tip in your book to make beans more digestible and cause them to be less likely to get, people who are saying next to an airplane, pissed or anything else. So, what’s your tip? What’s the secret?
Robynne: So you should know that beans are part of why they cause smelly gas and almost everyone is concern coz they contain a carbohydrate called raffinose that is not digestible by almost 2 months. They don’t have the enzyme oligosaccharides to break it down. So, if you use a sea vegetable like kombu, soak them overnight and cook them with the sea vegetable that really helps to break down the raffinose. And of course, soak ‘em using dry beans as opposed to canned beans which tends to be much more gas producing. Yeah, I’m a huge fan of legumes also. I think if you can tolerate them, you should have them.
Ben: And you talk about and you say something called kombu?
Robynne: Uhmm, it’s a sea vegetable. You can get it at wholesale food stores.
Ben: Okay, so you just basically cook your beans, you cook them with the sea vegetable and that breaks down this raffinose enzyme.
Ben: And so, I am obviously soaking and sprouting, and fermenting beans as important because I know that they kinda like pre-digest and get rid of some of the enzyme inhibitors, but I never thought about cooking beans with sea vegetables. That’s really interesting. The next time you makes some chili, throw some sea vegetables in there.
Robynne: It absolutely helps.
Robynne: And it adds to the flavor.
Ben: I don’t think that the cowboys of the old West did that, but….
Ben: They also had crappy coffee. And probably lots of gut issues. Well, there’s obviously a ton that we did not get in to that. That’s in both these books, The Microbiome Solution and The Bloat Cure. I read them both. Obviously when I read a book and I like it, I try to get the author on the show. So, I will vouch for both these books and not just full of crap that you read in other places. They actually interesting and full of advice that seems to be somewhat practical in the trenches probably because Robynne helps people poop all the time.
Robynne: Oh they’re full of good crap it’s what I think of it, Ben. Thank you Ben.
Ben: Yeah. You’re not just sitting in your mom’s basement Googling ways to poop. You’re actually out there practicing this stuff and smelling patient’s butts.
Robynne: Manually disimpacting people and smelling their butts, right?
Ben: That’s right.
Robynne: it’s really good stuff.
Ben: Well, Dr. Chutkan, thank you for coming on the show today, and for those of you listening in, again all the show notes, her books, everything that you need to poop like a champ, and much more, you can find over at bengreenfieldfitness.com/bloat, that’s bengreenfieldfitness.com/b-l-o-a-t, and Dr. Chutkan, thanks for comin’ on the show!
Robynne: And thank you so much for having me, and for the record I think you’re probably one of the least bloated people I’ve ever met, so… keep on doing what you’re doing.
Ben: You know what? When I was a bodybuilder, I used to have horrible farts, horrible gas. I have fixed so much overtime. My wife just loves me now like when we wake up in the morning, and the room doesn’t smells just like night and day vs. the first 6 years we’re married, so yeah. It’s big time happiness and your life loving relationships when you fix this stuff. So, yeah! That’s it folks. Thanks for listening in and until next time. I’m Ben Greenfield along with Dr. Robynne Chutkin signin’ out from bengreenfieldfitness.com, have a healthy week!
You’ve been listening to the Ben Greenfield Fitness Podcast. Go to bengreenfieldfitness.com for even more cutting edge fitness and performance advice.
In the beginning of this episode, I mention “Michael Phelps cupping” and what the research really says about whether cupping does or does not work, and also mention a new study on 20-25% gains in lean muscle gain, strength and power, and this HMB-ATP stack that uses exactly what they used in the study (use 50% discount code BEN50).
When it comes to healing your gut, getting rid of bloat and constipation, changing your gastrointestinal bacteria or any other digestive topic, I consider Dr. Robynne Chutkan to be one of the smartest women on the face of planet.
She is on faculty at Georgetown University and founder of the Digestive Center for Women, and she is author of not one, not two, but three books that focus on her primary philosophy: healing your body from the inside out.
So basically, she really loves talking about poop.
Her latest book, The Microbiome Solution, is a deep dive into how and why some of our modern day living is actually causing more problems than we realized to the tiny microbes that keep us happy and healthy– household cleaners, air conditioning, processed food. In that book, she talks about eating poop, timing your probiotics, getting a dog to lick your face, eating dirt and more.
In her other book, The Bloat Cure, she looks at less of the science and more at the practical nature of our bloated bellies, talking about how bloat isn’t just bad Chinese food, but also things like codeine in cough syrup and dehydration and birth control pills and GMOs.
During today’s episode, you’ll discover what I learned from reading both these books, and much more, including:
-How Dr. Chutkan can actually “smell” gut issues with her patients…[16:25]
-What it means if your sweat smells funky…[21:00]
-What pig whipworms and hookworms have to do with getting a healthier gut…[24:30]
-Why the Bedouin tribe eats camel feces when they have gut issues…[34:00]
-Why the “poop pills” everyone seems to be talking about don’t work…[52:50]
-Which common musculoskeletal imbalance can cause constipation, no matter how healthy you eat…[55:56]
-Why your medications and supplements may be making you constipated, and what you can do about it…[62:30]
-How wine can be either good or bad for your microbiome, depending on when you drink the wine…[67:45]
-The best time of day to take probiotics if you are also taking antibiotics…[69:30]
-Beans cause bloat for lots of people, you’ll discover one special ingredient you can add to them to keep this from happening…[72:55]
-And much more…
Resources from this episode: