 So, welcome to the Dr. Gendry podcast. On today's episode, I'm going to discuss something that may be a little uncomfortable for some people to talk about. Yes, I'm talking about what goes on in the bathroom. Poop. But, even if bathroom talk can put you outside your comfort zone and you can quit giggling right now, I promise you're going to learn a lot in this episode. We're going to talk about what your poop can tell you about your health and what a healthy poop looks like, the causes of constipation, bloating, and diarrhea, and why you might never need to use toilet paper again. Don't believe me? Well, listen in and find out as we talk all about poop. So, topic one, what exactly is poop? Now, what's fascinating to most people is we've always been told that our bowel movement is basically unused food particles that weren't absorbed from our small intestine and large intestine. And believe it or not, I was taught that in medical school. And that was before we actually learned about the microbiome. And for those of you who have listened to me, the microbiome is those hundreds of trillions of bacteria, about four to five pounds of bacteria that live in your primarily colon, but also in your small bowel, and there's even some that live in your stomach. So the vast majority of what comes out of your rare end is actually living bacteria. And that's what's so interesting. It is the vast majority is not residual things that you ate. It's the bacteria that ate what you ate. Now, why didn't we know that? It turns out that so many of the bacteria, particularly that live in our colon, cannot live in oxygen. They're what are called anaerobic bacteria. Bacteria that can live on oxygen are called aerobic bacteria like aerobic exercising. And for those of you who hit junkies, anaerobic exercise is when your muscles no longer burn oxygen and have to produce lactic acid, anyhow, most bacteria in our colon are anaerobic. And it's very difficult to grow anaerobic bacteria in traditional culture medium. So for years and years and years, we actually had no idea how much of our poop was bacteria. But thanks to the Human Microbiome Project, we now know that actually the vast majority of what you're pooping out is dead bacteria, pieces of bacteria, and living bacteria. So these bacteria get made by eating the foods that you eat. And that's where it gets into some very interesting things about feeding bacteria what you want them to eat. And as most of you know who've read or listened to the longevity paradox, there's a big difference between the bacteria that you want living in you and the bacteria that you don't want living into you. And that's why we're going to talk about this today. So first question, what should a good poop look like? Well, there's no absolute definition of you having a perfectly looking poop. If you listen to my good friend Dr. Terry Walls, when you have a bowel movement, you should look into the toilet and see a giant coiled snake looking back at you. And those of you who have heard this story, when I was writing the Plant Paradox, I actually in my unedited edition said that when you look into the toilet, you should see a giant anaconda looking back up at you. And my dear editor Julie Wills said, you realize there is a movie called Anaconda where an anaconda comes out of an airline toilet. She said, I don't think we want that visual in the book. So we changed it to a coiled snake. But the point is, you want a large mass staring up at you from the toilet bowl. And if it looks like soft serve ice cream, that's okay. If it looks harder and has markings, that's also okay. What you don't really want to see is actually floaters. If you have consistently floating stool, that means it actually has a high fat content. And almost all of the fat that you eat should be absorbed and not be in your stool. And that actually can mean that you have a digestive enzyme insufficiency. And it's one of the first things to spot. If you've got floating stools, then one of the first things I recommend doing is getting yourself some digestive enzymes. And those can be both bile acids and pancreatic enzymes. These are readily available. You actually don't have to spend a lot of money. And just start taking digestive enzymes with your meals and report back to see if you've got some nice sinkers in your stool. Now, topic two, why is poop important? Those of you who have done water fasting or juice fasting may have noticed that you will lose about three to five pounds in a three or maybe four-day water fast. And most people think this is miraculous weight loss. But what you've actually done, and you probably noticed this in the bathroom, is you took away the food that your gut bacteria generally eats. And so that weight loss is, interestingly enough, that four to five pounds of bacteria that make you their home. So rather than some miracle, that weight loss is just those bacteria not eating and, in a way, starving to death. I've done this so many times I get a kick out of it. If I go on a three-day water fast, I will, no matter what my weight is, lose about three to five pounds. And then when I start eating, I will, once again, gain those three to five pounds, maybe minus one pound for the three days that I didn't eat anything. But it always comes back, and that's because I'm regrowing my microbiome. So the more you think about what's living inside of you, and as I talk about the longevity paradox, what's living inside of you is incredibly important for your long-term health. Now what's equally as important, and this is where we get into constipation and diarrhea and bloating. We know that there are bacteria that should normally exist in all of us. Again, there's at least 10,000 different bacteria that have now been discovered that potentially can make us their home. And this number goes up all the time. About six months ago, another 1,000 species of bacteria were discovered through the microbiome project. The problem is the vast majority of us have very few species of those 10,000 bacteria. And that's because of what I talk about. Number one, we all take too many antibiotics. Now don't hear me wrong. Antibiotics properly administered can be life-saving, and that's not what I want you to hear. In other words, antibiotics properly done should be life-saving, but we use them excessively for colds, the flu, which they don't work on. Most of our ailments that we catch or viruses that antibiotics don't work on, they're in almost all of our conventionally raised animal products, whether it's the beef you eat, the chicken you eat, the pork you eat, because they've been fed to these animals to make them fatten up quickly. Antibiotics are in our water supply. It's something that really can't be filtered out by water treatment plants. So we're under this constant barrage of things that destroy our microbiome. And the most recent addition to the problem is glyphosate, the active ingredient in Roundup. Glyphosate was patented as an antibiotic. It absolutely destroys gut bacteria, and it's one of the main reasons I think our health has deteriorated and our bowel problems have increased. So normally we have this huge, great, diverse flora of microbiome, and they're there waiting for you to feed them. But so many of us, that microbiome is very deficient. And we have very few bugs doing the work. Now the bugs we do have in general fall into two categories. And you've heard me talk about good guys or gut buddies and gang members. And the good guys, let's start focusing on them first. The good guys actually like what are called prebiotics. Prebiotics are primarily what used to be called soluble fiber. And we'll come to insoluble fiber in a little bit. But soluble fiber are long-chain sugars. They're called polysaccharides. And these sugar molecules are very difficult for us to digest in our stomach and our small intestine. And they arrive undigested primarily into our colon, where they are eaten by the gut buddies. The more of these long-chain sugars that you eat, the more the gut buddies eat and they make little gut buddies. So you've got family after family of gut buddies. And what's fascinating with soluble fiber is that you get giant poops. Because that soluble fiber is eaten by your gut buddies and they make more gut buddies. And so that's where these big giant poops come from. Now insoluble fiber is the exact opposite. And as it name implies, insoluble fiber cannot be digested by any bacteria. And what's interesting about insoluble fiber is, I like you to think of insoluble fiber as swallowing razor blades or nails. And there's very good proof that insoluble fiber actually irritates the lining of your intestines. And you are so irritated from these razor blades going through you, that it makes you have a bowel movement. It actually stimulates you to have a bowel movement because you're trying to get rid of these things. What's fascinating is most insoluble fiber is from the halls of grains. So for instance, wheat germ is all insoluble fiber. Wheat germ agglutinin is one of the worst lectins and it's insoluble fiber. The insoluble fiber on the lining of barley or rye is insoluble fiber. And so the things that so many people take to promote regularity are actually some of the worst things that you can use for bowel health. And I've talked about this in the past. The idea of fiber being healthy was discovered by an English surgeon by the name of Dennis Burkett. English surgeons, and I was one of them in my training, are called Mr. rather than Doctor. So he is Mr. Dennis Burkett. And some people know him from Burkett's lymphoma, which he discovered and named. But he was a colon surgeon who went on missionary work to Africa to operate on poor African people who had colon problems. And unfortunately when he got there, he couldn't find any colon disease. He couldn't find diverticulosis. He couldn't find diverticulitis. He couldn't find colon cancer. And he said, what the heck? You know, what am I going to do down here? And he became fascinated by the giant mountains of poops that these Africans would have. And he said, well, he became a poop fanatic. And he would go around following these Africans out into the field and measuring their poops, photographing their poops. And he said, wow, it's these giant poops that are preventing them from having these colon diseases. And he saw that they were primarily eating prebiotic fiber, mostly in the form of yams. And so he said, aha, it's the fiber in these yams that they're eating that makes them resistant to colon cancer and diverticulitis. So fiber is what we should be eating. He got back to England. And England had a lot of fiber as foods, but they were in the form of wheat and oats and rye and barley, and they actually didn't have a lot of yams and sweet potatoes. He didn't know, but he thought fiber is fiber. So the idea that you should be eating fiber came from him observing soluble fiber and not realizing that insoluble fiber was actually a problem. So that's where the entire concept of fiber being beneficial. So people like Dr. Terry Walls and I will tell you that, you know, having these giant mounds of poop every day is a great idea. Now, should you have one or two or three, again, it really depends on how much soluble fiber is going into your diet every day. Now, as you know, Dr. Terry Walls would like you to eat about nine cups of vegetables every day. That's a lot of vegetables. My wife, Penny, and I eat a giant mixing bowl of salad every day, and I would say that's about, oh, six or seven cups of various lettuces and leaves every day. On the other hand, most people on a practical basis cannot do that. So that's the way that the idea of getting prebiotics either in a form of powder or even in the form of capsules came about. And there are a lot of ways to get prebiotics in you. Again, some of my favorite prebiotics are inulin. You can buy it as a powder. You can buy it as a sweetener. You can find it in, for instance, the sweetener sweet leaf. It's also in the sweetener just like sugar. Inulin is very present in the chicory family of vegetables like radicchio, the Italian red lettuce, it's not a lettuce at all. In frisee, in Belgian endive, it's really present in artichoke hearts and artichokes. It's great in Jerusalem artichokes, some people call it sun chokes. Another option that's very cheap is you can get psyllium powder, which is a great prebiotic. You can actually use flax seeds, ground flax seeds are a great prebiotic. Another option is to get yourself apple pectin. It's readily available. It's really cheap. It's another great prebiotic. One of my favorite prebiotics is modified citrus pectin. Now, unfortunately, it's pretty expensive, but it's been actually shown to break up what are called biofilms of bad bacteria in your intestines. I use it extensively in my patients who have really bad markers of biofilms in their intestines. We can measure this on blood tests. Many times what I see in most of my patients with diarrhea and or constipation is they're eating a very high lectin diet. Just remember that lectins break the tight junctions on the lining of our gut. Not only does that allow lectins into our gut wall, but spoiler alert, it's actually the cause of water entering the lining of our gut and into our bowels. This was actually discovered by Dr. Fasano from Johns Hopkins, who realized that cholera and most of us have heard of cholera, it's one of the most deadly diseases there is, and cholera victims die of massive, massive watery diarrhea. Dr. Fasano was fascinated with, well, why does the cholera bacteria cause this? He found that the cholera bacteria actually broke tight junctions, and when those tight junctions broke, water from our bloodstream and our lymph flooded into our gut and that caused the diarrhea. It was that observation that he learned that gluten, which is lectin, uses the exact same pathway as cholera does to break tight junctions. Spoiler alert number one, if you have a problem with diarrhea, the first thing I want you to do is get lectins out of your diet, and I think you'll be rather impressed with what happens, and that's one of the first things I do with any of my patients. The second warning I have, and a lot of my patients with diarrhea, do not realize that even foods in the future that are going to be really good for you to eat, particularly raw vegetables, raw cruciferous vegetables in particular, have lectins in them, and believe it or not, there is a lectin in spinach that some of us react to, raw. When we ingest those, and we're having problems with diarrhea, it often makes the diarrhea worse. So if I have a patient with gut issues with diarrhea, I don't let them have raw vegetables, raw cruciferous vegetables first. They can have them, but they basically got to cook them within an inch of their life, particularly in a pressure cooker. So if you've got diarrhea and you're listening to me and you're reading the plant paradox, in there kind of hidden saying, hey, if you've got intestinal issues and diarrhea, don't start with the three-day cleanse and don't eat a lot of raw vegetables, and it's a really good trick to remember, because those in and of itself will give you diarrhea. I'm reminded, and I think I've talked about this, early on, my wife Penny got a Nutribullet, and she decided to make me a kale smoothie. And we don't eat a lot of kale, but we do eat kale, but I don't eat it ground up and pulverized, and so I drank my kale smoothie, and I tolerate raw vegetables extremely well, but a few hours later I was in the bathroom and my kale smoothie left along with the rest of my abdominal contents, and I go, what the heck? And I realized that even though I was incredibly tolerant to raw vegetables, my dear wife Penny had broken every cell wall down, and I was assaulted by the lectins in raw kale, and even I couldn't tolerate it. So, word of warning, if you've got diarrhea, raw kale is not your favorite friend, particularly in a homogenized smoothie. Last but not least, I was on a podcast recently being asked about, well, don't prebiotics cause gas and bloating? And the answer is oftentimes they do. The famous gaps diet, which is an elimination diet of fermentable foods and quite frankly prebiotics are fermentable foods, is a great way to get rid of gas and bloating. But quite frankly, the gaps diet, as I've talked about, is probably the worst diet for your long-term health, because you really need these gut buddies to make incredibly powerful compounds like butyric acid, like propionic acid, like other short chain fatty acids that not only feed the wall of your gut and keep it healthy, but actually is some of the most important compounds to feed mitochondria, particularly in your brain. So eliminating these gut buddies by starving them of what you want may lessen your bloating and gas, but in the long term, it's the worst thing that you could do. And I'll tell you as I tell all my patients, yes, you may get more gas production, you may get more bloating initially, but that always quiets down. And give me a month and you'll notice the difference. OK, topic number three, fecal transplants. I have the pleasure of being one of the first contributors to fecal transplants in the modern era as a student at the Medical College of Georgia and Augusta Georgia in the early 70s. During that time, we had a outbreak of what's now called C. difficile colitis. And most of us are now aware of C. difficile colitis. We didn't know what the bug was back then. But it occurred as people were given broad spectrum antibiotics. That was a modern miracle in antibiotics because it killed just about everything. Unfortunately, we didn't know it, but it killed off our entire microbiome in our gut. And C. difficile is a very tough bug. It's a normal part of our Florida. Every one of us carries C. difficile, but it's kept in place by all the other microbiome. When that microbiome was killed off, C. difficile is having a field day. One of my mentors, Arlie Mansburger, who was the chairman of surgery at Georgia, said, you know, I think we've killed off all the good bugs. And there's a bad bug. And I think the only way we can get rid of this is to give people good bugs. And who would he turn to but medical students? Because, gosh, medical students must have good bugs. So once a week, they would pass around what was called the honey pot. And we would go into the bathroom and we would have a bowel movement in the honey pot. And he would take it back to his lab and he would put it in a wearing blender. I kid you not. And he would homogenize medical students poop. And we would put it in an enema bag and we would give people fecal enemas. And he got a lot of grief for this and a lot of jokes. But he was able to prove that within several days of getting a fecal enema, that this, what was called pseudomembridocemeral colitis, which is called C. difficile now, went away. And he had these amazing pictures and people accused him of forging the pictures. But it was, it worked. And of course, we now know it works. So we didn't understand at that point of this huge, dense, you know, population of bacteria. But he was brilliant in realizing that somehow broad spectrum antibiotics had changed our gut flora. And now we know that, in fact, fecal transplants can be used. So the power of fecal transplants has been used to look at the effect of the gut flora on making people fat or making people lean. And one of the earliest studies was taking germ-free mice and germ-free rats. And these are mice and rats that were raised from birth with no microbiome. And I actually did my fifth grade science project on that. But they take feces from obese individuals and feed them, humans, and feed them to germ-free mice or rats. And those germ, believe me, mice and rats loved to eat poop. They became obese. You could take feces from lean individuals and give them to obese germ-free rats. And they would become lean, proving in fact that the bacteria in your gut has a huge influence on whether or not you will be fat or skinny. And we now know through some very sophisticated experiments that there are certain bacteria that are really good of extracting most of the calories that you consume and, in their gift to you, pass it into you. Now, if you're obese, that's exactly what you don't want in you. And when I talk about gut buddies, the interesting thing about gut buddies is they're very selfish. And they actually want to eat everything that you ate and don't want to give it to you. And the reason you know that that's what's happening is your stool volume increases. And so that's your gut buddies taking the vast majority of the calories that you're eating and saving it for themselves, growing more little baby gut buddies. And that's why, like I say, you want to see a giant coiled snake in your toilet every day. Now, what about fecal transplantation in general? There's a very exciting study that was published this year out of Arizona State University using techniques that were developed in Australia for autistic kids. And I think it's probably one of the most important papers that we'll look back at and say, oh my gosh, we had no idea how powerful the human microbiome is. Briefly, they used crapsules, which are fecal transplant material that can be swallowed. And I won't give the details of the study, but they did it right. They sterilized kids with autism's gut. We know that kids with autism have a very bizarre microbiome. It's completely abnormal. They sterilized the gut with antibiotics. They suppressed acid production in the stomach because, quite frankly, most probiotics are destroyed by stomach acid. They then seeded these kids with what are called crapsules, their fecal material in capsules. And then they've now followed them for two years. And in summary, over two years now, about 50% of the autism symptoms have ablated. And if you've got a kid with autism, a 50% reduction in symptoms two years after this fecal transplant is life-changing for you and your child. And I think that really shows the power of where this is going. Now, don't run out and get a fecal transplant. You can't buy crapsules. We do have people who go to Europe where this is available. It's sometimes available in Canada. It is under research here in the United States, so you can find a center that could enroll you in a research trial. But the last thing you want to do is, quite frankly, eat your own poop or give it to your kid. That's not what I'm suggesting. Is fecal transplantation iffy? Yes, indeed it is. Because you can, unfortunately, be transplanted with things you don't want. There's a famous marathon athletic woman who developed C. diff. She got a fecal transplant from a cousin. We try to do fecal transplants with relatives because you're likely to have the similar microbiome. The cousin was 30 pounds overweight. This marathon runner recovered thanks to that fecal transplant. But despite returning to irregular activities over the next year, she gained 30 pounds because she was transplanted with an obesogenic population from her obese cousin. It's one of the first reported human examples of be careful what you wish for. Save her life, but she's got an obesogenic set of bacteria. So there is a trend in the poop world that you should have a stool that goes under your toilet, that lifts your legs up. Now, certainly in the wild and having been a Boy Scout for many, many years, Eagle Scout, that's how you naturally poop. On the other hand, that is not a necessity for having a natural poop. Believe me, if you have four or five pounds of gut buddies producing every day, they'll come out easy and smooth without you having to strain, without you having to get in the perfect position. Quite frankly, if you're having to get in the so-called anatomic perfect position to have a bowel movement, there's something else that you should be changing. Okay, it's time for the audience question. Viking Sandra asks on YouTube, are eggs good or bad? I know you mentioned omega-3 eggs in your book, but they're not always easy to find. What about regular eggs? I'm sure it depends on how they raise their chickens, too. Yeah, that's exactly right. Actually, omega-3 eggs are on almost every grocery store that I've ever walked into in this country. They may have different brand names, but I go all around this country lecturing or talking, and I usually go in grocery stores often to find something for me, but I usually look for omega-3 eggs, and they're there. Pastured eggs are becoming more and more frequent. We've even begun seeing producers who are saying, our chickens are not fed soy or are not fed corn, and do the best you can. But omega-3 eggs, the chickens are in general fed flax seeds or algae or both. It's difficult to raise a chicken completely on algae because, quite frankly, their shell gets too thin and it's not commercially profitable. But these things are pretty common. Are they good or bad? The yolk in the egg has some pretty cool stuff for your brain, including choline. There's a lot of controversy about eggs. I can tell you that in my autoimmune patients who have really leaky gut, about a third of them we're now finding will react to some components of eggs. There is no necessity for eggs in your diet. There are pretty good egg replacements out there. The vegan egg, which I talked about in the plant paradox, is now made with soy, so I do not recommend that. Bob's red mill egg replacer is probably the safest out there. Don't be afraid of the little bit of potato starch in there. There are no lectins in potato starch, but don't run out and buy lots of potato starch. That's probably the safest one out there right now. So that's your question about eggs. Don't be afraid of them. Omega-3 eggs are available. Can you poop without toilet paper? First of all, we are the only animal that actually uses toilet paper. Think about that. Take your dogs for a walk. They don't use toilet paper. When I tell patients that Dr. Berkut noticed that Africans didn't use toilet paper, he was shocked because everybody needs to use toilet paper. And quite frankly, I was shocked when I changed my diet. Yes, I do use toilet paper, but no, there is nothing on the toilet paper. And many of my patients, when they come back to see me, said, you're right, I really don't need toilet paper. How did you know? I said, because this is what should be coming out of you. You weren't born with a need for toilet paper. And it was such a shock to me, having used maybe a half a roll of toilet paper every day, that oh my gosh, what happened? And it was because I totally changed my microbiome. I totally stopped my leaky gut, and water wasn't pouring into my gut. And I see so many patients who are on anti-diarrheal thinking that that's somehow normal for them. So it's not normal. And work with me, and maybe you won't need toilet paper anymore. It'll save you so many trips to Costco, believe me. That's all for the Dr. Gendry podcast today, and we'll see you next week.