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Understanding Poop and Why It's the Window to Your Overall Health [E053]

old man running on trailIn this episode, Dr. Bryan Joseph interviews Dr. Anthony Pasek on why understanding poop and its importance can help you live a happier healthier life! If you are one of those people who is currently experiencing digestive issues or gut concerns, listen up. It could save you trouble in the long run.

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Table Of Contents

An Introduction To Understanding Poop

Dr Bryan: This is Episode 53. We’re going to have a discussion today that is not for the faint at heart. If you have a sensitive gag reflex, if you have a sensitive stomach, this may not be your favorite topic. However, there’s a ton of clinical relevance behind it, and that’s why we wanted to have this discussion.

Dr Anthony: Well, we’ve got to keep it clean, so understanding poop.

Dr Bryan: All right. Today we’re going to have a discussion around poop. Understanding poop can change your overall health.

Dr. Anthony is with us today because he has done a lot of clinical practice around this particular topic. And the value of understanding what’s in somebody’s stool. And we want to share to you today, the importance of understanding that. What are some of the ways to best understand that in today’s world of what we have available?

“All Health Starts In The Gut”

Dr Anthony: Yeah, definitely. I don’t remember who it was, one of you two might. Socrates or one of those old philosophers said, “All health starts in the gut.” So back in the day, people knew the importance of the digestive system for your overall health.

Dr Bryan: I think we’re hearing that more frequently. Circle back around, I think more and more people come in to conversations, sharing that, “Look, I know that my digestive tract is a mess, and I’ve read or heard that if my digestion is off, then the rest of my body is not going to be right.” Dr. Olivia and I have talked about the importance of detoxing which is not unrelated to this topic.

And there’s a ton of truth and relevance to that statement, and that’s what we’re going to break down a little bit. But in addition to people just knowing that their gut is of vital importance to be healthy, those of you that don’t know that it’s a vital importance to be healthy, many people are experiencing digestive trouble and symptoms.

So if you’re on the standpoint where you just want to stay healthy, and stay well, and understand what’s in your gut, and how to stay healthy, this is going to have some relevance to you, and some weight. Or if you’re already past that spectrum and you’re experiencing symptoms, and maybe some trouble with your health, this will also have some relevance to you.

Stool as an important biomarker

Dr Jason: Hormone tests, MRIs, advanced testing. And even openly, my journey in getting to know you better, and some of the more advanced testing that we’ve brought in here, is opening up and being okay with, that understanding poop actually tells you a lot as a very important biomarker as well. Not really comfortable for me to be openly.

It’s not something I want to talk about. But there is data in there that really can make a huge difference on not only preventing disease, but living really well. I mean, last night we had dinner and Dr Olivia and Dr Bryan came over and we were talking about, now tests can be used in lieu of colonoscopies to detect early forms of cancer.

That can be done at home. So there’s a lot of validity behind understanding poop, even if it’s culturally hard for us to discuss, because it is. But I think it’s important for people to recognize it’s a really important biomarker.

Dr Anthony: And I think you mentioned a good point. Not all tests are created equal. So you could go to your family doctor and they’ll do a blood test, and they might tell you everything looks good. But really, the level of specificity that you get into, what markers you’re actually looking at are important. So that test you mentioned is called Cologuard. That’s basically screens for cancer. But it’s not necessarily the same thing as the testing that we do routinely here on patients, which is much more advanced, looking at good bacteria and infections and leaky gut and inflammation and things like that.

Dr Bryan: Let’s take a high arching view first. Let’s climb up in the helicopter and look down.

Dr Anthony: Great.

Why Understanding Poop Is Important

Dr Bryan: Why, first of all, as a clinician and someone that’s actually spent time studying the human body, why do you feel that there’s so much value? Because you’re a proponent of actually analyzing and understanding poop. But why?

Dr Anthony: That’s a great question. So I think it’s helpful to talk about what other approaches can be done, like a colonoscopy for instance. So that’s looking at a bird’s eye view. You’re actually just looking at the structure of the intestine, so you can see if you have a big tumor, for instance, or an obstruction where the path of that system has been cut off. Or if you see ulcers or something like that.

So those are things that you can see with your eye. You actually get pictures that come with the report for that. But when you’re looking at a stool test, you’re looking more at the microscopic level. So not just actually looking through your eyes, but looking at what bugs are there, and the importance for that is pretty broad.

There are a lot of patients that I’ve seen that have exclusively psychological symptoms, like anxiety, or even emotional and behavioral disorders, where we find the most clinical important findings are a worm infection or something like that. That wouldn’t show up on conventional testing. Even a regular stool test to screen for those things, or a colonoscopy. Those are things that you have to look at deeper. So if we look at skin disorders, or brain disorders, or metabolic disorders. All of those things, we can get information about them by looking at the gut. Looking at understanding poop.

A full suite of diseases can be detected by understanding poop

Dr Bryan: That’s fascinating because what I’m hearing you say is, you’re not analyzing people that specifically have gut problems, with a stool test. This could be a full spectrum of everything. Health conditions from mental conditions, to skin disorders, to autoimmune conditions, to muscle-skeletal, joint inflammatory problems. But so what bacteria is inside the intestinal tract has a value on a systemic level.

Dr Anthony: But then of course, if somebody has primarily digestive complaints, of course we would want to be looking there too. So we hear a lot about reflux, acid reflux, or heartburn type situations, and often that’s some type of bacterial imbalance that we’ll see as well. Or constipation or diarrhea. All of those things, we can get insight into that by looking at the gut as well.

But one example when we talk about the brain connection, is there’s a lot of new evidence that says basically Parkinson’s disease is gut inflammation that travels up one of your nerves into your brain. So it’s not so much starting in the head, but really like a direct line of transit from the gut up to the brain. So that’s one example that’s most people don’t think of when we talk about what the implications of this testing is.

Dr Bryan: So in traditional healthcare settings, when somebody has abdominal issues or digestive challenges, like you mentioned, it may be commonly approached to be able to provide a colonoscopy which is a tool to look for pathology. Polyps, tumors, obstructions, or maybe a CT scan of the abdomen to look at imaging or pictures of that whole region. But what a really functional stool test can do, is to help us really understand what’s called the microbiome, right?

Dr Anthony: Yes

What Is a Microbiome?

Dr Bryan: So what is the microbiome, and where is it found?

Dr Anthony: That’s a great question. I think the definition, if we’re going to talk about what microbiome means, it’s everything that’s part of us, that’s not our human cells. So there is a microbiome on almost every surface and every part of your body.

The story I always tell is, if an alien came and landed here next door, and they did a bio scan of us and said, “Well what makes you up?” Of all of the cells on us, 10% of that is our human stuff that we think of. Our liver cells, our skin cells, our brain. So really, 90% of what makes us as a living being, is not us. It’s the microbiome. So if we were to look at that perspective, we’re actually more microbes than we are us.

It’s like 10 times more not us than it is us, which is pretty cool. Let’s talk about the different layers of that. The gut microbiome is the biggest one we think of. Starting from your mouth, all the way out to the other end, there’s just a huge amount of bacteria and other microbes that live in that system. All over your skin, there’s a normal microbiome. I’ve shared this with you, but there are probiotic deodorants that you can get now that are effective at restoring the armpit microbiome. Your eyes, lungs have a microbiome.

So there are all kinds of different micro-environments of microbes, all over our body. So there’s some evidence that even things like cataracts and other eye issues are an imbalance of those microbes. It’s pretty crazy.

A delicate balance of good and bad bacteria

Dr Jason: It just made me think of is, when you’re saying this, and it really puts into light how devastating the overuse of antibiotics are for the entire human organism. Not just for the fact that we’re creating antibiotic suppressant sicknesses, but we’re destroying the homeostasis of the human body. And then all the other stuff that we’re doing with GMO foods and things of that nature too, that are only destroying… This is crazy.

Dr Anthony: It’s far reaching for sure.

Dr Bryan: So everyone of those environments that you just spoke of on the human body, is really a representation of its own ecosystem. And from what, I’m just piecing together some of the things that I’ve heard you say, as well as my wife say, is there’s good and bad… You used the word, “Bugs” earlier in this conversation. There’s good and bad bugs.

And basically the end result of anybody’s individual ecosystem, or environment, is going to be dependent on how many of the good bugs are available, and how many of the bad bugs are available.

Dr Anthony: It’s a very delicate balance. It’s all kind of like Goldilocks. You can have too much. You can have too little. So you can have too much good bacteria, or you can have not enough good bacteria. You can have too much bad bacteria. I don’t know if there’s such a thing as not enough bad bacteria, I’m not sure. But there’s a fine balance for all of those things. So it is important.

Look At Our Yards To Understand Your Body

Dr Bryan: So for all of you that are listening, and I was having this conversation off the record just a little bit ago, and it’s a visual that might make you hopefully better understand what’s happening inside of your body, before we go any further in regards to understanding poop, is when we look at our yards, when we’re trying to grow grass out in our yard.

If our yard is the ecosystem or the environment, the result we’re trying to create is nice, healthy lawn, full of grass. But all of a sudden a fungus approaches that environment, or a certain bacteria that’s harmful to your yard, and you get these patches that start growing abnormally. Or you get a dead spot where the grass can’t grow. Now that ecosystem is disrupted. And because it’s disrupted, it’s not going to function as well as it could have, if it was otherwise not disrupted.

Take that in terms of, in your own mind, of what Dr. Anthony’s describing for these ecosystems with these bacteria inside of our intestines. So if we have an intestinal tract that’s supposed to have a lot of, for lack of a better word, healthy bugs or bacteria, but we’re killing them off with a, as Dr. Jason said, with a lot of antibiotics, we’re making room for the patches in the yard to start showing up inside of our guts. And the more that that shows up, the more we’re allowing dysfunction to begin.

Dr Jason: When those patches show up, as Dr. Bryan alluded to, that is destroying the lining of the intestines and then making it almost impossible for us to absorb the nutrients that we need to run the body.

The good news: our bodies can get better

Dr Jason: So you’re killing the microbiomes that we need, but on top of that, destroying the tissue. So now you see it on the colonoscopy but that it represents the fact that you destroyed the ecosystem far before that. The tissues change, and now you can’t even absorb the good foods you are trying to eat.

Dr Anthony: The visual that they use is if you zoomed in on your gut, it should look like a shag carpet. There should just be lots of deep valleys and crests and stuff like that. But if you just imagined cutting those fingers off of that, that can happen to your gut.

But the great news is, it’s very, very dynamic. And those tissues have STEM cells at the base layer of that, and they regrow and regenerate in a matter of days and weeks. So you can really see improvement in that area as well. So it’s a two way street. It can get worse, but it definitely can get better. Our bodies want to be natural. They naturally want to be healthy, and repair and regrow, and meet that homeostasis. But if you’ve got weeds growing, sometimes that makes it harder.

How microbiome in your stool can help us

Dr Bryan: Let’s now move this into the conversation of actually understanding poop. Because if the body parts, like the intestinal lining, is supposed to have this microbiome on it. A lot of times people just think of your stool as this undigested or digested food. So what else are you discovering in this, and how is this sample helping us?

Dr Anthony: When we do the testing, we’re looking at the actual genetics of the different bugs that are in your gut. So you can see how many different types of good bacteria you have. And are they too high, or are they too low, or is there infections? Is there yeast? Is there worms and parasites, and stuff like that?

Dr Bryan: So I guess here’s what I’m asking. As food is moving its way through the channel from mouth all the way to the other end, are those bugs getting clung onto the stool, and that’s how we’re able to now identify what’s in the ecosystem?

Dr Anthony: This might be a little gross, but a large portion of the weight of stool is actually dead bacteria. So it’s a constant flux of that. It is undigested food. It is enzymes. It’s actually skin cells and stuff from your intestine.

So a lot of it is food that you’re eating, and undigested parts of that. But it is just sort of a natural… Just like your skin. You constantly lose skin cells. The same thing happens. The lining of your gut is very, very similar to the outside of your skin. So, for people that have things like eczema, or patches and stuff on their skin, usually that’s a direct reflection of the health of the skin of their gut.

DIY Ways To Check Your Poop

Dr Bryan: Jason, you give a great analogy, like an exfoliant of the skin. So as you’re passing any material through your digestive tract, it’s basically pulling off things from the sides, in which the practitioners like yourself can interpret this data, to say, “What is living in this ecosystem?”

Dr Anthony: So obviously the testing is super helpful, but there’s some very low tech ways you can just give yourself an assessment of like, “How’s my poop doing?”

I have this discussion with pretty much every patient at one point. A normal bowel movement. I have had patients come in and I ask, “How are you doing with digestion?” “Oh, fine. Normal.” And I ask, “How often do you have a bowel movement?” “Oh, once a week.” It’s like, “Okay, well that’s not normal.”

So let’s just clarify what normal is. So just like a baby, when they eat, they should have a bowel movement. There’s a normal reflex where when food goes into your stomach, you should move your bowels. So certainly one time per day, bare minimum. Usually first thing in the morning, or after food or coffee is a normal stimulus. And then up to four to five times a day. So if a baby’s eating that often, they might be having that many bowel movements, and then that would be the frequency. So if you’re going any less often than that, I would consider that constipation. Or if it’s really, really firm.

So the consistency, a good normal bowel movement is like, just close your eyes and picture McDonald’s frozen yogurt coming out of the machine, right? So soft serve ice cream. That’s a good normal consistency.

Other indicators to check on your poop

Dr Bryan: Everyone’s going to look at ice cream differently now. Everyone.

Dr Anthony: So frozen yogurt. Soft serve ice cream. So if it’s a lot firmer than that, then that can indicate constipation. If you’re having really, really loose, unformed stools, that can be diarrhea. So yeah. I look at my understanding poop every time I go. I’m just trying to figure out what my gut health is like. So check it out the next time after you go.

Dr Bryan: Does color have any… Is there a normal color, or no?

Dr Anthony: That’s a good question. It can vary. It’s probably better to say things that are look abnormal. Obviously if you see bright red blood, that’s not great. Sometimes if it looks like the color of coffee grounds, that can be an indication of bleeding in the stomach and stuff like that. Or if it’s really, really green, that can be a sign of liver or gallbladder problems.

Dr Jason: I’ve clearly noticed a difference in color when I’ve… So you know me pretty well. So I get in these spots where I’m very rhythmic with my green smoothies, my supplementation. And then I also will go way off the grid, right? So I will go on my in-laws house on Thanksgiving, and I don’t see a vegetable for three days, and I love it. Right?

I absolutely can see a difference in my stool, when I’m eating vegetables, when I’m minimizing my overuse of processed foods, versus when I go off the deep end and I don’t see a vegetable for three days, I eat a ton of sugar and everything I eat that’s meat, is usually fried. They’re totally different. There’s just a different hue. It’s everything. It’s just, it’s different.

How To Bring Back A Healthy Microbiome

Dr Bryan: We’re starting to understand now that the benefit to having your stool analyzed. It can help us in a lot of ways to stay healthy, because our gut is a representation of our overall health.

And now we find that our microbiome, and our bacteria, and our fungus or worms, whatever we find in the stool is really out of whack. Now what do we do? How do we restore that? What are some of the common practices to bring it back to a normal, as healthy or normal of a microbiome as it can be?

Dr Anthony: Right. So it depends on the case, but the general approach would be, we usually find something that needs to be killed, like an infection of some kind. So there are many, many herbal tribe time-tested remedies that you can take. Things like berberine, and oregano oil, and stuff like that, that are just plants that are known over time to help kill infections.

If we’re looking at how do we grow those good bacteria, we mentioned prebiotics. So fibers from the food that you eat. There’s also a supplemental prebiotics that we use, and even supplemental probiotics, so taking a pill. But if you’re looking at the overall way to really grow the levels of good bacteria, it comes from prebiotic fibers and fermented foods.

So fermented foods really put supplemental probiotics to shame. Now, that doesn’t mean that, we use probiotics every single day here. But if you’re looking at the quantities, the numbers of good bugs, the entirety of one bottle of a probiotic, you might be able to get the same number of microbes in a few teaspoons full of sauerkraut, for instance.

Eat fermented foods like Kimchi

Dr Anthony: Now, probiotics. Very useful. I’m sure we’ve had many different discussions about that, but that’s a whole other topic we could do on its own, because they serve a very good purpose and they have an important place.

Dr Jason: So if I heard that correctly, would it behoove us in general to have a small jar of sauerkraut in our fridge, and just take a tablespoon or a teaspoon of it every day?

Dr Anthony: Absolutely. Back in the day it used to be hard to find good quality fermented foods, but you can find them really easily at any health food store now. I even have patients that make their own. But having some type of fermented food on a regular basis is a really, really good idea.There’s other versions and things.

Dr Jason: Kimchi.

Dr Anthony: Exactly, is like an Asian sauerkraut. It’s a little spicy. Really any vegetable can be fermented. I mean, if you’re doing it yourself, anything and everything goes. So the way you ferment food, the way the process works, if you go and buy a jar of pickles or coleslaw that’s at the grocery store, it’s probably been pasteurized, which is where they just basically sterilize the food.

So it may have been fermented to start, or it may not have been. But you basically, if you were making it at home, you take cabbage and you let it sit in a crock without exposure to air. So you would weigh it down so that’s covered with water and then you let it sit there for a few days. And the natural bacteria that are there grow and divide, and that’s it.

Closing Thoughts

Dr Bryan: All right. As we come to a wrap on this podcast episode, this was Episode 53, and you know the purpose of this episode stays the same. It’s always to help you become more aware, or help you get well and stay well as long as you can on the journey that you have for your own health. If for nothing else today, hopefully that we introduced a concept that you may have not been real familiar with, which is that there’s a lot of value to understanding poop, and it serves a purpose.

If you’re looking for someone that can help you with that specifically, we’d be happy to point you in the right direction. But I can guarantee that all of us will probably be looking in the bowl a bit differently after today!

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