The Poop Episode: What's Normal?

Episode Transcript
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Speaker 1 (00:00):
This podcast has been sponsored by QOL Medical and
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Maintaining a healthy gut iskey for overall physical and
mental well-being.
Whether you're ahealth-conscious advocate, an
individual navigating thecomplexities of living with GI

(00:20):
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The Gut Health podcast willempower you with a fascinating
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(00:42):
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We are your hosts.

Speaker 2 (00:47):
I'm Kate Scarlata, a GI dietitian, and I'm Dr Megan
Riehl, and we have a reallyexciting podcast for you.
Today we're going to be talkingabout all aspects of a topic
that makes some people anxious,some people maybe giggle or
squirm, some peopleuncomfortable, and then also
just so many people are curiousabout this topic.
So what is it?

(01:08):
It's bowel movements, poop,bm's.
You know we always have athousand different questions.
Probably, when you know, youmight turn back and look what's
going on back there, and now weare going to bring you an expert
, as well as both of us, to talkabout this.
So, before we get into ourguests today, we just want to
share a couple tips and tricks.

(01:29):
When it comes to an effectiveexit strategy, we'll say and so
the first one that comes to mindis the thing that happens when
we first wake up, and sometimeswithin about 30 to 60 minutes of
being upright, our body startsto give us cues, and it's really
important that we listen tothose cues and get yourself to

(01:51):
the bathroom.
And so you know, just like it'simportant to listen to our body
regarding all kinds ofdifferent things in our world,
using our intuition, your gut istelling you something and we
definitely want to take care ofit when we need to in the
morning.
We've got a lot of other tipsand tricks when it comes to
bathroom usage, and so, kate,maybe you could share a couple

(02:13):
of your favorite tips and tricksthat you find to be effective
in this category.
I love that.

Speaker 1 (02:19):
So, first and foremost, I'm a huge fan of the
squatty potty.
This is a toileting stool wherewe raise our knees above our
hips and what that does is openthe rectal canal angle, which
really allows for just a littlebit more of a straight line shot
into the porcelain throne.
That's what we're going for.
So engage your squatty potty isimportant part of the proper

(02:42):
pooping position and, yeah, wetalk about this in mind your gut
, Dr Riehl and I.
And so a proper poopingposition is when your feet are
slightly elevated, again, kneesabove your hips, and you lean
forward about 30 to 35 degrees,and Dr Riehl always mentions
that this is a really good timeto do some deep cleansing

(03:02):
breaths, which we'll get into,because that really does engage
that pelvic floor and that'spart of this whole effective
proper pooping position that weencourage our patients that have
maybe a little bit morechallenges in the potty.

Speaker 2 (03:19):
Yeah, but anybody can benefit from it, right?
I mean, when we go into thebathroom and you think about a
good cleansing poop, you wantyour spine to be straight, you
want to be in that properposition Three P's we could even
call it and so anyone,regardless of your bowel habits,
can really benefit from this.
And you mentioned thediaphragmatic breath.

(03:40):
So, again, whether you're maybesuffering with some struggles
having complete evacuation iswhat we like to look for and
hope for or you're somebody onthe urgent side.
The diaphragmatic breathing isgoing to help to calm and soothe
those digestive muscles.
We're going to talk all kindsof tips and tricks, answers to

(04:00):
your questions today, and we'regoing to be joined by our
amazing guest.
Really our privilege tointroduce our guest, the one and
only Dr Jami Kinnucan.
Dr Kanuken is known for herdynamic personality, her
incredible patient care skills.
She's a thoughtful mentor tomany and really an advocate for

(04:23):
women in the field of GI.
She's also an inflammatorybowel disease specialist.
She joined the Mayo Clinic inFlorida in January of 2021 as a
disease specialist and is asenior associate consultant in
the division of gastroenterologyand hepatology.
Now, prior to this, she waswith me as an assistant

(04:43):
professor of medicine atMichigan Medicine, and so
certainly we miss her up in theMitten State.
But in addition to leavingMichigan and really bringing her
leadership skills and reallyjust she's such a wealth of
information for the field of IBDand GI in particular.

(05:03):
So you know, we're just solucky to have her today, and not
only is she going to share allof her information on poop, but
she also does research in thearea of cannabis and IBD.
She's recently received a 2024stardom award to look at virtual
reality and how this impactspatients with pain.
So you know we could pick herbrain all day long, but today

(05:26):
we're going to pick it aboutpoop.
So welcome, dr Kanukin, andwe're going to start with a myth
buster with you, because that'show we like to dive into things
.
So you know what are somecommon misconceptions about gut
health or GI disorders that youthink are important to dispel
for our listeners today as weget started?

Dr. Kinnucan (05:46):
Well, thanks for having me, and I would love to
meet this Dr Kinnucan.
She sounds pretty great, but Iam so excited to be a part of
this.
Very, very interesting andoften not talked about, you know
very much.
People often don't feelcomfortable talking about their
poop, so we're going to talkabout all things poop today, and
I hope that people feel reallyconfident when they look at

(06:07):
their poop, that they know whatmight be contributing to.
You know kind of what it lookslike, but myth buster, all right
, so I'm going to do maybe amore general one.
I think that people forget thatthey are what they eat, and so,
kate and your field, you know, alot of the things that we put
into our bodies, you know, canhave direct impact on the way we
feel every day, and so I thinkwhen people come in not feeling

(06:28):
well, one of the first questionsthat I talked to them about is
what their day-to-day intakelooks like, and oftentimes
that's just a really easy placeto start.
But in the field ofinflammatory bowel disease which
probably many of your listenersdon't have this, but maybe some
of them do, you know many ofour patients come in feeling
better when they change certainthings about their diet.
They may be avoiding fibers,they may be avoiding
lactose-containing foods, butthat feeling better often makes

(06:51):
you feel like, well, my diseaseis better.
So my Crohn's disease isgetting better because I'm
feeling better, and that'stypically not always the case.
So, while foods can make usfeel better, we don't have a lot
of data that changing specificthings in your diet will lead to
ultimately change the amount ofinflammation that you have from
either ulcerative colitis orCrohn's disease, and there's

(07:11):
been some larger studies thathave helped looked at this.
Do I believe that food doesn'tplay a role in terms of the risk
of inflammation, the risk ofhaving a relapse of your
inflammation?
Absolutely, I think what wefeed our bodies is so important,
but I don't know that we'vereached the understanding yet
that diet alone is going to beable to treat inflammation.
So one of the things that Iwant to myth-bust today, at

(07:31):
least for those patients withCrohn's disease and ulcerative
colitis, is you know, while youmight feel better with certain
food changes, don't be fooledthat that's actually making your
inflammation better, and sodon't stop your medicines with
the idea that maybe your dietarychanges are going to be what's
going to fix the inflammatoryprocess that's happening, so
hopefully that helps some of ourlisteners today kind of think

(07:52):
about how they're interactingwith their diet and their
inflammatory bowel disease.

Speaker 1 (07:55):
Excellent, excellent.
I love that because I do thinkwhen people feel better
sometimes, especially ininflammatory bowel disease, you
know that they're on the righttrack and they may be from a
symptom management.
But you got to take a look andreally listen to the doctors
because medication is reallyparamount for many patients with
that condition.
So let's get some learn somedeets on poop, let's get into

(08:19):
some details.
So is there a thing like theideal poop?
Is there the best shape, forinstance, in lightness?
What are we looking for?
What's the golden, I don't know?
Trophy poop, what is it?
Oh gosh.

So I get so proud when my three and a half year
old has that perfect poop.
So let's kind of talk aboutwhat that looks like.
I think that there's noperfection to poop but there
certainly are poops that aremore ideal in terms of what they
look like.
We on the medical side and ifyou've ever seen a
gastroenterologist, you may haveseen a Bristol stool scale and
if you haven't, you can go andGoogle it and it will give you a
range from one to seven ofdifferent types of poops and you

(08:59):
can identify kind of whatmajority of your poops look like
.
So the sort of ideal poop is aBristol stool scale three or
four.
It should be easy to push outwithout excess fluid or liquid.
So a type three and sorry toruin if you're about to eat any
sausage.
Type three is like a sausagebut with cracks on its surface.
And then a type four is like asausage or a snake, smooth but

(09:21):
overall very soft, and this isreally kind of that.
Type four is really the middleground, average stool.
But we'll tolerate type threeand four and there's variations,
kind of even within a day oreven within your week, and
that's okay and that could verymuch be impacted maybe by what
you fed yourself or if you werestressed or if you haven't slept
well.
So I think you have to expectvariation, but the majority of

(09:43):
the poops, when they're more inthis ideal state, is that type
three or four.

Speaker 1 (09:47):
Love it.
I always tell my patientsthey're not dogs, you know
they're not eating the samething.
Live in the low stresslifestyle on the couch, you know
.
So the change in diet andstresses, so many factors, play
a role in what's going to, youknow, show up in the toilet bowl
.
But I like that.
Three to four is the goal.
Snake like it's a good target.

Speaker 2 (10:09):
And on that scale.
So one is going to be very likepebble, hard constipation.
Seven is going to be looseliquid diarrhea, and so you know
you might, you might start at atwo and you know, get up to a
five on in a given day, and thatvariation does not need to
cause anxiety or worry, it'sjust a matter of you know.

(10:31):
This is a tool, a strategy tostart to give us some
information in an objective wayabout the consistency of our
poop, and I didn't touch on thecolor.

So that's sort of the consistency, but I'm looking
forward to talking about therainbow color of poop.
But what does normal poop looklike from a color standpoint?
Again, this can actually vary.
You know, any shade of reallykind of a greenish to more brown
shade can be within that sortof ideal poop color range.
But it really is dependent onwhat you feeding your guts.

(11:02):
That can really kind of changethat variation.
And so stool color can be veryimpacted by what you're eating
but also the amount of bile, andbile is typically made by your
liver.
It helps you digest fats, andso little bile can lead to
variations, and maybe we'll talka little bit later about the
rainbow colors of poop.
And then a lot of bile can makeit look more yellow, green, and
so it really is dependent on alot of those factors too.

Speaker 1 (11:24):
Awesome.
So let's get a littlemicroscopic.
What is poop made up?
You mentioned bile, but whatelse is in poop?

Yeah, so we're gonna get a little bit
interesting but maybe a grossquestion because probably many
people don't think about, likewhat is actually in my poop.
But let's get some scientifichere.
Poop actually typicallycontains about 75% water with
some mixed in organic solids.
So what are those organicsolids?
Well, bacteria is really thelarge component of that and

(11:53):
that's why the microbiome andfeeding a healthy microbiome is
so important and can help yousort of move towards that more
ideal poop In terms of formationand color.
And there's some variation.
Anywhere from a quarter to 50%of your organic solids are this
bacterial.
Biomass.
Nitrogen-based matter makes upanother portion of those organic
solids, and then 25% of yourpoops can be carbohydrates or

(12:17):
undigested plant matter, andthen there's anywhere from 2 to
15% and when we start to get onthe higher range, that can
actually represent amalabsorption issue when you
have too much fat in your stool.
So the last component is fatthat's in your stool.
So really, the things that youput into your body proteins,
carbohydrates, fats are thethings that are getting broken
down, some of them gettingabsorbed and then much of them

(12:39):
you're pooping out.

Speaker 1 (12:40):
Love it.
So we kind of touched uponcolor of poop and I know I've
had a couple clients beenfreaked out after eating beats
and have a bowel movement andsee Bright red in their stool.
And is this blood?
Am I dying?
You know, if you're not chewingwell, those beats are gonna
show up in the poop and they arebright red and it can be scary.
What does the color of poopmean?

(13:04):
Like, what are some of the?
You know we touched upon someof them, but would green come
from something in particularoutside of bio?
Could you elaborate a little onthis?

Happy to walk through.
I have a funny story aboutgreen poop.
I think actually Dr Riehl wasaround for this green poop story
.
My kid ate a St.
Patty's Day green frostingcupcake and the poop that came
out about 12 hours later was thesame color as the frosting.
So I think what the story meansto tell you is that a lot of
things that you put into yourbody can actually Change the way

(13:37):
that your poop looks from acolor standpoint.
So you mentioned green poop.
So think about it when you see avariation in your poop color is
did I eat something?
So green poop, leafy greenvegetables, green food coloring,
kind of think about thatfrosting standpoint, actually
iron supplementation.
So you can also think aboutwhat did I eat.
But also, are there anymedications that I'm on that can
change my poop color?

(13:58):
And so I think that can kind ofguide you when you start to see
variations in color Diarrheaand excessive bile.
So if you have too much bile orif things are moving too fast,
even though you didn't maybe eatanything, you can get more of
that green coloring to yourstool.
Now on the other spectrum iswhat happens if you have no bile
in your stool, so light colored, clay colored stool.

(14:19):
So again thinking through, didI eat something that might have
turned things that color?
Also medications, againanti-diarrheals can actually
create that.
So when you've taken a Imodiumover the counter you can see
more of those whiter stools.
Maybe bile had more time toreabsorb and you're not seeing
as much bile in the stool.
If we think about some of thethings within the GI tract that
can maybe create that lightcolored or clay like white stool

(14:42):
a Bile obstruction.
So if you have a gallstone thatis sitting in your bile duct
and preventing bile from beingexcreted from your liver and
Other things, things that arevery rare, like a biliary cancer
or a pancreas cancer.
So bottom line is, if you seesome light stools and they're
happening more regularly, thisis something you should seek
medical attention for.
Now, yellow stools, greasystools, can be seen if you're

(15:06):
taking certain gluten containingfoods.
It can actually typically asign of excess fat in the stool
due to either malabsorption orhigher intake.
Malabsorptive disorders thatcan cause excess fat could be
something like celiac disease.
But there's quite a few thingsthat can impact the small bowel.
This typically, if you'rehaving routine yellow, greasy

(15:27):
floating stools, I would seekmedical attention with primary
care or gastroenterologist.
The last two colors areactually what ones that you want
to ensure that you're kind ofheightened awareness on?
So do you see dark black stool?
Two common medications that cancause that are iron supplements
or anything that contains abismuth, like a pepto-bismal or
a Kale pectate which gosh, Ihaven't taken that since I was a

(15:49):
kid.
Also, if you think about things, you eat black licorice, it
goes in black and it's gonnacome out and it's gonna discolor
your poop black.
But if you see more of thatsticky tarry molasses kind of
consistency and you're seeingblack stools, this can actually
be a sign of something moresignificant happening, like
bleeding in the upper GI tract,something like your esophagus,

(16:09):
your stomach or the first partof your small bowel.
So black tarry stools don't sitat home.
This should prompt you to getmore urgent evaluation.
And then the last one is redstools and I think you brought
this up, kate, that red stools,you know, beats common thing
that people take in.
Red food coloring can do thatas well.
Cranberries of around Christmastime, thanksgiving, all that
cranberry sauce, you ate tomatojuice, you drink a lot of Bloody

(16:31):
Mary's maybe, or red coloredgelatin or drinks that can also
create that red stool, but younever want to miss the fact that
it might be blood.
So if you're having consistentstools that are looking more red
in color, this is something wecan easily test for.
So just get a test, make surethat there's not blood in the
stool and if there is, thatshould prompt more urgent
evaluation with the health careteam.
So important and I think youknow for some people talking

(16:53):
about their poop.

Speaker 1 (16:56):
It's this embarrassing or I can't broach
the subject with my doctor, orI'll just wait it out.
We all talk about poop in ourpractice.
I think all three of us couldsay that's probably a regular
discussion.
So just really important totake yourself to the health care
center, talk to a nurse at thedoctor's office.
Whatever you need to do, thisis not a topic to keep to
yourself.
We're all ears.

(17:19):
We love talking about poop.

Speaker 2 (17:21):
You're right, Kate, that you know we've probably all
had multiple patients wherethey'll say, like I'm really
embarrassed to talk about this,but I know you probably talk
about this, you know, with otherpeople and so I'm gonna just
share with you and I'm like, yes, absolutely, and they'll make
comments about we never talkedabout this in my family.
I didn't know this wasn'tnormal or I didn't know what
normal was.

(17:42):
And part of our motivation fortoday's episode is to, you know,
demystify some of thisinformation and to also maybe
encourage us to again normalizethe book.
Everybody Poops.
My kids have a book called Whatis Poop and you know we talk
about that.

(18:02):
Going to the bathroom issomething that you do, your
friends do, your parents do, weall do it.
We just want you to be surethat you're not going to be a
part of this.
We just want you to be healthyand if there are some alarm
features regarding your bowelhabits, then let's be mindful of
that and make sure that we havethe right help.

Does anyone feel that we should have gone to
school to learn how to poopRight like what to eat, how,
what position we should be in?
I don't think anyone teachestheir children.
No one taught me.
I think you figure it out bywhat helps you, but I feel like
we all need to take a class inhow to poop.

Speaker 2 (18:38):
I love that idea poop class yeah, kindergarten,
everybody like learns how topoop.
Yeah, you know, we should bringthat up with our elementary
schools.
I love it.

Speaker 1 (18:49):
I love it.
So should we delve into likejust changes in poop consistency
, constipation, diarrhea?
Do you want to talk a littlebit about Dr.
Kinnucan?

Sure, we're talking about all things poop
today, I think you know.
Thinking about consistency, Iwant to kind of throw in a
common question I hear is howoften should I be having a bowel
movement?
Right, and I'm sure both of youhave experienced that, because
what's one person's normal itmight not be another person's
normal.
So I think everyone has theirown normal.
But how do we define, you know,constipation?

(19:19):
Well, constipation is definedas small amounts of dry, hard
stool, typically fewer thanthree times per week.
So if you're not having thoseBristol stool scale three or
four or at least three times aweek, you might be more on the
constipated side.
And then diarrhea maybe is theother spectrum where you're
having more liquid, loose,watery, urgent, frequent bowel

(19:40):
movements, maybe during the dayand maybe at night.
So let's dive into, kind of,some of the things that we think
about, at least on thehealthcare side, and maybe this
will help the listeners when,when they hear this, kind of
understand like am I that person, am I having those those ideal
three to four type Bristol stoolscale, three to four type bowel
movements, or am I on theharder side, pebble side, or am

(20:02):
I on that more liquid side?
And so the way that I thinkabout constipation is really in
two ways.
Are there things that areslowing down a colon?
That's where poop usually isformed.
So it's formed by Dehydratingthe chyme, which is the
substance coming out of yoursmall intestine.
It empties into your colon andnow the colon's job is to take

(20:23):
as much liquid out as it needsto, to maintain this volume
status, this hydration statusfor your body, to keep you kind
of upright, not feeling likeyou're dehydrated.
But then it's also a job is tomove that now Hopefully perfect
Lincoln Log from one place tothe other, so not everyone's
colons are as efficient in doingthat, so you can have more

(20:44):
delayed transit issues withconstipation.
Actually, one of the things thatI see in patients who've
struggled for lifelongconstipation and then I'll ask
them about is tell me about whatit's like to have a bowel
movement.
What do you do?
Do you have a routine youtalked about, kind of sitting on
the porcelain, goddess you know?
Are you maneuvering?
Are you having to lean forwardand back, or do you use a
squatty potty?

(21:04):
Do you have to use differentmaneuvers?
Some women have to stick theirfingers into their vagina to
actually force a bowel movementto come out into the toilet and
not a lot of people feelcomfortable talking about that
and they certainly aren't goingto maybe offer that information
up.
So I'm encouraging you ifyou're sitting in front of a
physician or a team member onthe healthcare team talking
about your bowel movements, behonest about the things that you

(21:26):
need to do to have bowelmovements, because that could be
a sign that maybe your colon isworking really well.
It's getting poop from point ato b, but then it's getting
stuck.
Because the pelvic floor is soincredibly complex.
There are muscles and nervesand interactions that have to
happen between your mind andyour gut and if those aren't all
working perfectly, you may notbe able to push that perfectly

(21:48):
can log out and different thingscan put you at risk for that.
Women, we are notoriously atrisk for pelvic floor issues or
pelvic floor dysfunction.
We have children and sometimeswe breath and vaginally.
Obesity can lead to pelvicfloor dysfunction.
If you are prone to heavylifting or straining, that can
cause and create challenges inyour pelvic floor.
So even if your colon isworking great, your pelvic floor

(22:09):
might not be.
And some common causes to thingsthat really are around that
delayed constipation includesmedications.
Medicines that we take canimpact our colon motility.
The most common medication thatcan do that is a narcotic which
slows down everything basicallyin the entire gut and that can
create delays and things togetting from your mouth all the
way to your bottom or into thetoilet.

(22:30):
If you don't move or you don'texercise a lot.
Moving your body is actuallyone of the ways that you can
have those more ideal bowelmovements on a more frequent
basis.
If you're chronicallydehydrated, you are asking your
colon to work so, so hard to beable to dehydrate that stool.
It's creating those littlepebbles or making that stool
really, really hard, and, trustme, it is much harder and much

(22:52):
more painful to pass hard stool.
It is that nice soft stool.
Maybe you have underlyingirritable bowel syndrome with a
more constipation predominant,and that can create some
challenges.
And of course, who's traveledright?
If you go on differentvacations or if you're going to
work meetings, you're probablyeating a different diet, you're
probably not drinking as muchfluid and so travel alone,

(23:13):
getting on a plane, can createsome digestive issues and can
make you not be on your regularschedule.
And then actually people whohave been chronically using
laxatives can actually createsome sort of dependence around
that and there are very safetherapies that we use that can
be used long term, but there aresome therapies that actually
are used for stimulants and thenwhen your colon is not exposed
to them it's not moving as fastas it needs to to create that.

(23:34):
So that's really kind of how Italk to patients when they're
coming in and they are kind ofmeeting those criteria for more
constipation symptoms.
But on the other spectrum ofthat scale, those patients are
having more Bristol stool type 6, type 7, more of those liquid
stools.
What are the common things thatwe think about are causing
diarrhea.
So you are what you eat and sothere are different foods that

(23:55):
can create more challenges withyour gut.
So dietary causes is usuallynumber one.
So I at least get a basicunderstanding and, Kate, I know
you probably dive far more intodetail than this but are you
eating dairy predominant foods?
Do you eat gluten?
A lot of people are glutensensitive but don't actually
have a true allergy to gluten.
Fructose containing foods cancreate a lot of gas, bloating

(24:17):
and diarrhea and I think thatgetting this high level of
intake and understanding abouthow your food intake is
impacting your bowel movementsis really important An actual
diagnosis of celiac disease.
There is a small portion of ourpatients in our country more
common in patients who are inIreland but we can see a gluten
allergy and so that's celiacdisease.

(24:38):
But many people go gluten freethat actually don't have an
underlying diagnosis of Celiacdisease and it may not actually
be the gluten.
We might be more worried aboutsome of the wheat that might be
in the foods that they're in.
If you have too much bacteriain your gut, too much bacteria
can create excessive productionof gas and gas kind of moves
everything out of the way andmakes it harder for you to

(24:59):
absorb the fluids that you needto, and so you can see more
fluid in your stool and make itmore diarrhea-like consistency.
Certainly, medications can putus at risk for diarrhea, and
some of the more commontherapies that's prescribed and
actually now available over thecounter that can create issues
with diarrhea is using protonpump inhibitors.
People also have been reading alot about taking magnesium and
that magnesium is going tochange everything for them from

(25:22):
a healthy point, but it actuallyhas been giving them diarrhea.
Caffeine, gum sweetenersdifferent ingestions can
actually create diarrhea.
So I often ask patients ifthey're gum chewers.
I feel like gum chewing used tobe like an 80s thing.
I don't feel like people chewthat much gum anymore, if that
you have too much bile.
So let's say you had agallbladder removal several
years ago and ever since thenyou've noticed you've had issues

(25:43):
with looser stools.
Well, bile is stored in yourgallbladder.
So if you no longer have thisreally important organ, while
not everyone needs it you'regoing to probably be dumping
more bile into your system andnot absorbing as much of that
bile and it's going to begetting into your stool and you
might be seeing more of thosegreenish, yellow stools and more
liquid inconsistency.
And there are differentmedications that we can use for

(26:03):
that.
Of course, when people arehaving issues with both new
diarrhea, sudden onset doesn'tgo away, or they've been having
diarrhea for a while, we want tomake sure we're not missing
infection and so people can pickup different infections that we
can measure with differenttesting.
There's different causes ofcolon related issues that can
cause diarrhea.
There's things that I treatCrohn's disease and ulcer of

(26:23):
colitis and the most commonsymptom is often diarrhea.
And then probably the morecommon thing and really the
focus of that excellent bookthat I've had a chance to read
Mind Your Gut is Irritable BowelSyndrome, which can go on the
spectrum of those harder stoolsand be more on the more liquid
side, those diarrhea stools, andcan sometimes be in the middle.
So that's really how I kind oftalk to patients if they come in

(26:44):
with the understanding thatthey're feeling more constipated
or they're having more liquidstools.

Speaker 2 (26:49):
So you covered that whole spectrum right, like with
constipation, are you drinkingenough water, are you getting
good sleep, have you beentraveling?
Is your environment different,is your stress different?
All of that can impact thingsas well.
As you hit on the diagnosisthat we commonly hear in our
patients with, which isdisenergic defecation and about

(27:10):
50% of patients withconstipation will have that
diagnosis and in that instancewe might then introduce working
with a pelvic floor physicaltherapist and wherever you're at
on the spectrum number one, itcan feel uncomfortable to talk
about this with a physician andyou can kind of feel like, oh,
you know, I've taken the mirrorlaxer, I've taken the amodium,

(27:31):
I've tried to work on my diet,and you start to feel a little
bit hopeless, like what are theygoing to offer me, especially
if you've had a colonoscopy.
That was normal.
But the reality is we can startto look at that holistic team
and a pelvic floor physicaltherapist, a dietitian, a
psychologist, and it kind ofgoes back to this idea that one
provider doesn't have to do itall and you don't have to be

(27:51):
alone in the management of thesensitive issue.
So thank you for soholistically and comprehensively
covering you know whether youare urgent or you are the slow
turtle trying to make it to thefinish line here.

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Speaker 1 (30:14):
That's right, Megan.
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Speaker 2 (30:48):
The book is available in our show notes as well as at
all major book retailers.
So a couple other questionsthat I'm just curious about.
We're at a conference.
There's lots of people imbibingin alcohol and marijuana.
We can smell it wafting fromthe streets of Las Vegas.
Do those types of things, likeif you have a big weekend out do

(31:11):
those impact your stool?
And I think also we talk aboutthis with our college kids,
right?
How does alcohol and weedimpact our stool?

Great question, I agree.
So just for the record, we arenot partaking in excess in
either of those.

Speaker 4 (31:25):
one of which is an illegal substance.

So excessive alcohol is a sugar, and so
sugars can create some transientmalabsorptive issues, and so
you can see more liquid stools.
And if any of your listenershave, either in college years or
recently, have had a few toomany drinks, you probably notice
that your stools the next daymight be more on the liquid side
.
You might actually be on theother spectrum.
You actually might, becausealcohol can dehydrate you.

(31:48):
You might actually go onto theconstipation side and those
people may notice if they aretaken in excess alcohol and may
have more liquid stools.
And then you bring up a reallyimportant topic that patients
often talk about with me is theuse of cannabis and how can they
use cannabis to help them feelbetter.
But let's also understand thatcannabis can actually have a
significant impact on themotility of your gut, and so the

(32:08):
reason why patients who havebaseline diarrhea maybe feel
better when they're usingcannabinoids and that can be
cannabinoids, cbd or those thatcontain both THC with CBD.
There's direct impact.
There's endocannabinoidreceptors that are in your gut.
Actually, the largest volumeoutside of the penile gland,
which is in your brain, are inyour gut, and so when you're

(32:28):
using cannabinoid-likesubstances, especially daily or
chronically, you may see avariation in your bowel patterns
.
So some patients who usechronic cannabis can actually
notice that they're morenauseous, and they have chronic
issues with nausea because theycan get some delays in their
gastric emptying.
That also impacts their smallintestine and their colon.
So some patients may notice, ifthey were more on the diarrhea

(32:50):
side and now they're usingcannabis more regularly, that
they actually can have moreissues with either more normal
bowel movements or they may beon the more constipated side.
So again, everything you putinto your body can impact your
gut and it can impact the colorsyou see, the formation, you see
how often you see it, and so Ithink it's just important that
we're feeding our gut thehealthy things to try to obtain

(33:10):
those ideal poops so that wefeel better.

Speaker 2 (33:13):
Yeah Well, everything in moderation, right, and it's
important.
It's again.
We get nervous to talk to ourdoctors about this.
So now you don't have to askwhether you can, you know, but
if it's impacting you, then it'scertainly another factor to
consider.
Couple more questions.
Just curious and I'm sure thatmy seven year old will love this

(33:34):
question why does poop floatsometimes and why does it sink
sometimes?

Interesting.

Speaker 2 (33:42):
Sinkers and floaters.

So it's really again based on what you eat.
So your intake can change theway your poop looks, the way you
know, obviously, the color andthen sort of the consistency of
it.
So most toilet bowls have waterin it, so anything that is less
dense than water is going tofloat to the top, so things that
might have less density thanwater.
So your poop is more consistentwith either you've eaten a lot

(34:04):
of fiber, maybe you've had morefat, maybe you actually have an
issue with absorbing fat, and ifthat's the case we need to
evaluate that or maybe you havemore gas.
Maybe you ate some of thosefoods that are gas producing
foods which are very welloutlined in the book, those
FODMAP foods, and that cancreate more of these floating
stools, and certainly chronicfloating stools yellow, greasy

(34:26):
in color, with fat globules.
You can see.
That really should initiateseeking care with a healthcare
team member.
Those that sink just means thatthe poop is denser than the
water and that actually can be asign of a healthy bowel
movement.
So a type three or four thatsinks to the bottom goes right
into that person, goddess whole.
That's a great bowel movement,that's something to celebrate,

(34:47):
and so that's actually somethingthat is not very concerning.
And again, floating stools hereor there it's probably
something to eat, butconsistently having those
floating stools and that's moreof your regular, that may be
something that you need to bringup to a healthcare team member.

Speaker 2 (35:00):
Okay, so you've covered quite a few potential
signs of a digestive issue thatwe should probably look a little
closer at with a medicalprofessional.
What do you think are, like,the biggest red flags?
Just if you could summarize itbriefly so that people can kind
of keep it in mind, what arethose big red flags in terms of
your poop that we wanna just beaware of?

If there's anything that comes out of this
is people understand that youcan have variations.
It can vary within the day, itcan vary day to day, but it's
more of that if there is thisconsistent variation that we
talked about in terms of some ofthe things that maybe you would
seek care for.
So certainly if you see blood,you're convinced it's blood,
there's no question you need toat least seek care with your

(35:44):
primary care provider or agastroenterologist.
They should warn an exam socommon non concerning things
that cause blood hemorrhoids,both internal and external.
Internal we can't see, but wecan feel them if we do an
appropriate exam during yourvisit.
And then external we can seethem.
If you have a hard bowelmovement that's difficult to
pass, it can create a tear inthe lining of your anal canal

(36:05):
and that's called an analfissure and that actually can
bleed a lot more than you wouldthink from a very small area.
Let's just think about it likea cut there.
So blood 100%.
If you're having change in yourbowel patterns.
So whether that is, you're onthe diarrhea side, you're on the
constipation side and you maybe having some discomfort and

(36:25):
any weight loss.
So weight loss with any changesin your bowel patterns is
something that I would sayimmediate discussion with a
healthcare team member.
Weight loss is not somethingthat we see.
That with variations in bowelpatterns, it usually means that
there's something that'shappening.
It might be that you're noteating enough and that could be.
A simple answer is that you'vebeen trying to control your
bowel frequency with eating lessand so when you eat less you're

(36:47):
gonna lose weight.
But we wanna make sure we'renot missing anything.
You know, mucus can actually bea normal sign of stool, but
excessive mucus production, withor without blood, is usually a
sign there might be inflammationsomewhere.
So if you're seeing a lot ofmucus in your stool on a regular
basis, that would be somethingthat I would seek care for.
And then, of course, if youhave any changes in your bowel

(37:07):
patterns and you have a familyhistory of a GI malignancy
whether that's a colonmalignancy or anywhere in the
bowel bring that up with yourhealthcare team member.
Allow them to do the next stepsto really exclude some of those
things that would be, if wewaited, could be treatable,
reversible, but if we wait toolong, we ignore those important
symptoms, could actually lead tocatastrophic outcomes.

(37:29):
So I think look at your poopand if your poop is changing, if
you see blood, if you're losingweight, if you have symptoms
that are persistent beyond justkind of here and there, bring it
up with your healthcare teamand they'll kind of work up what
needs to happen next.

Speaker 2 (37:43):
Okay now just a thought came to mind for our
listeners 45 is the new 50 forcolonoscopies.
So unless you're reallyexperiencing a lot of alarm
symptoms and if you are havinghealthy, normal poops, then you
should likely have your firstcolonoscopy around the age of 45
, would you agree?

100%.
If you have a family history ofa colon cancer.
If your family history was thatthey were 45 when they were
diagnosed with colon cancer, youstart 10 years earlier, so you
don't wait until 45.
But, yes, most people averagerisk no family history,
otherwise feeling well, havingthose ideal poops, feeling good
about their gut.
Read your book, right, theyread your book and they're

(38:25):
feeling like their poops are onpar.
45 is the new 50.
And so make sure that you'regetting that.
And then I'm still pushingtowards colonoscopy over some of
those home stool-based testing.
What I tell patients is thosehome stool-based testing they're
really good at detecting cancer.
They're less good at detectingpolyps, and polyps are those
pre-cancerous areas, things thatI can take out as a

(38:47):
gastroenterologist and preventyou from having cancer.
I usually like to see patientshave one at age 45.
And if they're overall low riskand they have one at 45 and
they wanna opt in at 55 to maybedo some of those stool-based
testing or maybe in the next 10years we get better tests that
can predict polyps more thanthey're predicting cancers, then

(39:08):
I'm okay with it.
But I really struggle,especially with more in the news
.
You've seen, what we're seeingin the GI community is early
onset colon cancer, people thatare getting cancers earlier and
earlier, and so, personally,when I turn 45, not there yet
I'll be getting my colonoscopyand then kind of going from
there.
So that's I really encourage.
But screening, no matter whichway you do it, as long as you

(39:29):
get screened.
So if you can't take off work,if that's not something that's
in your cards you don't wannaget a colonoscopy, for whatever
reason that might be then I wantyou to get screened in some way
.
So poop it in a box.
If you haven't seen theSaturday Night Live video
hysterical, but poop in a box,send it off.
At least make sure that there'sno concerning findings there.

Speaker 2 (39:46):
Wonderful.
So last thing, that we'vepicked your brain a lot and
we'll probably all go have adifferent experience in the
bathroom the next time we gotoday.
Thanks to you and all of yourinformation, we'll either be
really reassured or maybe we'llmake a phone call.
We'll see.
But I think I know the answerpretty well to this, but I'd

(40:07):
love to hear thegastroenterologist's perspective
.
So how does stress impact bowelmovements?

gosh, I don't know that there's any listeners on
here that have never experiencedstress, right?
Stress impacts us in differentways, but, absolutely right, how
many people do you know thatsay that they have a nervous
belly right when they're askedto either speak in public or
they're in a stressful situationthat they're like I need to
have access to a bathroom andthey really don't have any other
issues outside of those moments?

(40:33):
But in those moments, thatconnection between your central
nervous system what's revving upin that stressful moment and
your enteric nervous system, thenervous system around your gut,
is so incredibly strong and insome people it's stronger than
others, and so some people canbe more impacted in those
stressful situations and thatthe way they feel stress is
actually in their belly.
So you know this.

(40:54):
I don't need to tell you this,Dr.
Riehl.
That mind-gut connection iscomplex and impacts people in
different ways.
But, yes, stress can impactyour bowel, but it doesn't
always have to impact your bowel.
Personally, when I'm stressed,it definitely impacts my gut and
I definitely know that I'mexperiencing some stress in my
life.

Speaker 1 (41:10):
Love it.
Definitely.
The gut and brain are highlylinked and so we have to, you
know, think about diet, followup with the doctor if your poop
looks a little funky and it'schanging and you're concerned,
and keeping the stress in check,or pay attention when you
notice that stress is definitelyimpacting you.
So I wanted to do just a quickhigh level, real quick, a couple

(41:33):
tips for diarrhea from anutritional standpoint or
supplement standpoint and I knowDr Kinnucan really talked about
a lot of these so I'll keep itreal high level.
But if you're prone to diarrhea, caffeine can definitely
stimulate motility.
So overdoing caffeine coffee,tea, chocolate can probably be a
culprit to some of the diarrhea.
Maybe dial it back a little bit.

(41:55):
We talked about alcohol, keepingit moderate.
Excessive alcohol can affectmotility, brings water into the
gut, can lead to excess diarrheaand have really negative
effects on the gut microbiome ifyou're overdoing it.
Another important sort oflifestyle factor is chewing your
foods.
Digestion starts in your mouth.
So if you're seeing clumps oflettuce in your stool, you're

(42:17):
probably not chewing very well.
So consistently seeing food inyour stool is something also to
pay attention to, especially ifit's recognizable chew a little
bit better.

Speaker 2 (42:27):
And that could be a sign that maybe slow down a
little bit.
Are you rushing through yourmeals?
Are you eating on the go, areyou?
You know I'm busy, mom right,we sometimes are standing up
eating our dinner while we'reputting the plated food that
looks beautiful down for ourtoddlers.
But you know, if you're seeingthat food and maybe you're also
acknowledging the role of stressin your life, use your poop as

(42:50):
your flag to check in and kindof recognize maybe I need to
slow down, maybe I need toprioritize myself a little bit,
and we all deserve to chew ourfood well enough to digest it
right.

Speaker 1 (43:01):
Amen, absolutely.
Another little trick fordiarrhea is cilium husk.
Because it's a gel formingfiber, it can really sop up
those extra fluids in the colonand make this stool a little bit
more formed.
Interestingly, it also worksfor constipation because it adds
some bulking and softening tostool too.
So cilium husk is one of thosefibers that not everyone

(43:24):
tolerates but is one that Ioften recommend.
And of course pelvic floorphysical therapy we talked about
that can be helpful for bothconstipation and diarrhea
predominant, especially withfecal incontinence and diarrhea
can be helpful.
And then in our patients thatyou know have that disnergic
defecation that Dr.
Riehl mentioned.
Any thoughts on constipation inlifestyle, Megan or Dr Kinnucan

(43:49):
?

No, I was actually going to ask you a question.
Can I ask questions?

Speaker 1 (43:52):
as the guest.

Speaker 2 (43:53):
You're allowed.

Can you explain to me and our viewers?
A lot of patients try fiber,but not all fibers are created
equal my understanding.
Can you explain soluble versusinsoluble fiber for both me as
the simple gastroenterologist aswell as for our patients,
because I think patients thinkfibers all the same.
I'll tell you my story, as Iwas eating a lot of those fiber
one bars and gosh, I had neverfelt more bloated in my life

(44:19):
than after eating those fiberone bars.
But I finally figured it out.
I was like, why do I feel sobloated?
And it was because I was eatingthose fiber one bars.
So what was I doing, Kate,right.

Speaker 1 (44:28):
So fiber one.
They use a lot of the chicoryroot or inulin as one of their
top ingredients and this is ahighly fermentable fiber, so
causes a lot of gas.
Even if you don't have asensitive gut, if you're downing
a couple fiber one bars, you'regoing to know that you are
downing a couple fiber one barsbecause it's a highly
fermentable fiber.
Your microbes are eating thatfiber like fast food and they

(44:50):
are creating copious amounts ofgas.
So to your point, soluble andinsoluble fibers just a generic,
you know, kind of describingcan the fiber mix in water or
can it not, or does it not mixin water?
And in general, soluble fiberstend to be the food for our gut
microbes and in general tend tobe better tolerated fibers.

(45:10):
An irritable bowel syndrome, forinstance, wheat bran, which is
an insoluble fiber, can reallycause diarrhea, mucus secretion
in the intestine.
So when we're thinking aboutfiber, just high level
solubility matters.
Is it going to mix?
Is it a gel forming fiber?
That's also really important.
We love gel forming fibersbecause they sop up the fluid,

(45:32):
can help with diarrhea and thenthey also soften stool.
So that is psyllium husk.
Another example that's in thatcategory would be beta-glucan,
which is in oats.

What about benefiber?

Speaker 1 (45:44):
Yeah, benefiber is wheat dextrin and actually that
can have a constipating effect.
So even though it's oftenprescribed for individuals with
constipation, it really doesn'tbenefit them.
So fiber choice matters and ifsomeone's highly gaseous, we
don't want to give them a fiber.
That's going to be highlyfermentable and we want to make

(46:05):
sure that the fiber is alsointact in the colon if we want
it to work.
In the colon it's completelydigested and broken down by our
microbes.
Because it's highly fermentable, it's not going to really
probably help with softeningstool or sopping up fluids.
So, yeah, did that answer yourquestion?

It did.
I mean, I feel fiber-educated,because I think that patients
come in saying I eat plenty offiber, Dr.
Kinnucan, I don't need morefiber.
And so now I feel like I havesome very smart words to use
when I'm talking to them thatyou probably aren't actually
eating enough fiber, or you'reactually eating probably the
wrong fiber, and so let's kindof help you eat the right fiber,
so I love those suggestions,thank you.

Speaker 1 (46:44):
Yes, and just to quick, since we're on the fiber
train right now.
So most Americans have about 15to 18 grams of fiber per day
and we're really trying to gofor about 25 for women and about
close to 35 for men.
So most of us are underconsuming fiber.
But different fiber tolerancesand different foods will work
individually because we have ourown individual fingerprint of

(47:06):
our gut, microbiome and justgenetics and a number of other
factors that play a role here.
So fiber should be tailored toyour body and what works for
that.
So I know we're, you know,don't want to run too, too late,
but just a couple constipationtips.
I want to mention the two.
Green kiwi fruits are myfavorite recommendation.

(47:26):
It's a well tolerated fruit.
You can add it to smoothies,but they have special fiber that
helps manage constipation bybringing water into the gut and
stimulating the motilityreceptors in the gut and can be
a really good nutritional,holistic approach to managing
constipation.

Speaker 2 (47:44):
Well, thanks, for those tips I always love.
Like the recap right.
We've covered so much.
You could go back and listen tothis episode over and, over and
over, and I've really let allof this information resonate so
that high level is reallyhelpful.

Speaker 1 (47:56):
Absolutely so I thought maybe we should do just
like a quick status update.
I know you and Dr Kinnucan arehanging together right now in
Vegas.
Did you want to share a littlebit about what's going on there?

Speaker 2 (48:08):
Yeah, so we're both here for the Crohn's and Colitis
Foundation Congress, which isreally bringing together experts
in the field in the world ofinflammatory bowel disease.
So Dr Kinnucan is heavilyinvolved in leadership.
I serve on some committees aswell and also, you know, really
just learning about theinnovative things that are

(48:29):
happening for this patientpopulation.
And so, as we said, we're inVegas and we're paling around at
the different offerings of thisexciting conference and always
fun to see my friend again.

Speaker 1 (48:43):
I love that.
You know one thing I reallynote with the Crohn's and
Colitis Foundation they are sogood about bringing in the
patient voice to their sessions.
I just it's so important tohear from the people that are
living with these conditions andtheir perspectives and just
haven't seen it done as well asthe Crohn's and Colitis
Foundation.
It's just.

(49:03):
It's pretty amazing what theydo, not only the patient voice.

Speaker 2 (49:07):
yeah, but the multidisciplinary perspective.
So at this conference there aresocial workers, there are GI
psychologists, there aredietitians, there are rectal
surgeons, there aregastroenterologists, so really
getting the perspective andinsight of how do we help
patients from a holistic,multidisciplinary perspective.

Yeah, and I would.
I was actually going to say isthat you know the same thing
that Megan's saying is that it'snot just about physicians, it's
, you know, about the whole team.
And one of the things you know,speaking about food and diet
and then I think, kate, you'veprobably been involved with this
is the the gut healthy recipesthat they have on the Crohn's
and Colitis Foundation and, andthose are actually recipes that
don't necessarily even need tobe specific to patients with

(49:47):
Crohn's disease and ulcerativecolitis.
I've used some of the recipesmyself and they're excellent.
They are kind of healthy,nourishing, feeding a healthy
microbiome, really kind offocused, but also geared towards
ulcerative colitis and Crohn'spatients.
You know more in thatMediterranean focus type diet,
so that's also another resourcethat the foundation has, so very
patient centric, I agree, andabout the team and and how do we

(50:08):
better care for patients as ateam?
So Absolutely.

Speaker 1 (50:11):
I can't say that I've created those recipes.
I have to give credit to KellyIsaacson and Laura Manning, I
think have been really key ondeveloping that.
But in addition to the gutfriendly recipes, just so many
great resources, not only forpatients but also clinicians.
I often go there to just checkout, you know latest on iron and
different topics and EMEA andwhat the recommendations are.

(50:34):
So that's awesome.

Speaker 2 (50:35):
We'll link some of these resources in our show
notes so that we'll give all ofour listeners easy access to
some of the resources availableonline.
And let's talk about mynutrition challenge, right?
So last episode, Kate gave methe challenge of expanding my
vegetable intake and I will haveto say, when I stepped back and

(50:57):
kind of looked at what I wasconsuming, we actually do eat a
pretty wide variety ofvegetables in our house.
It was just a matter of was Iingesting them as regularly as I
was giving them to my kids?
So God love the Costco formaking it a little easier.
I made sure in my last tripthat I got like the extra large

(51:20):
organic frozen veggie mix.
That really helped me bump upmy color variation.
But in the last month we'vebeen talking more about it as a
family, like what colors are onour plate.
I'll admit, I am the bagelgrabber in the morning.
So just having you know, kate,in the back of my mind as I was
getting my bagel was what couldI have with it?

(51:42):
And even this morning, you know, the cinnamon roll looked
really, really good.
I'm not saying that I'm notgoing to indulge later, but I
did grab the yogurt with thegorilla and the different
colored berries.
So I think, just havingsomebody with accountability and
encouragement, I over the lastmonth I've made some really
healthy choices and certainlybeen using like the smoothies

(52:04):
and salads to get that variety.
So thank you, kate, for thatchallenge.
My microbiome thanks you.
My kids' microbiome is.
You know, the kids were doingpretty good anyway, but a busy
mom was prioritizing herself alittle bit.

I have an important question in this All
of these changes you've made,have you seen a difference in
what the porcelain goddess sees?
She's happy honey.

Speaker 2 (52:28):
She's happy, I love it.

Kate making poop happy left and right.

Speaker 1 (52:35):
Exactly, that is exactly.
I am very well known as likethe poop person in all of my
friend circles, like everyone'salways, you know, like oh, she's
always talking about poop.
My father-in-law will say thatas well.
Oh, she talks about poop, she'san expert in poop.
Well, I have some very excitingnews.
What I want to first talk aboutmy challenge.

(52:56):
So I was feeling a littleanxious.
We were planning on getting apuppy.
We have lots of just work, Idon't know a book being
published, a new podcast, a fewextra things on my plate, and so
Dr Riehl really gave me arecommendation to get my butt
outside and do some more outsidewalking.
I definitely enjoy being innature and I really incorporated

(53:19):
nature walks not just walking,but nature walks and it is so
grounding for me.
And so I got three nature walksin this week and I heard your
little voice in the back of myhead saying just get your nature
walks.
Self-care is important for you.
So that really added a nicebalance to a very busy work week

(53:39):
.
So that was my positive.
In one other little bit of news, I learned yesterday that the
mama puppy, the chocolate labmom, just had her babies
yesterday.
So there are eight cutechocolate labs born, and so my
little girl pup is waiting forus.
So we'll be picking up ourpuppy in about eight weeks.

Speaker 2 (54:01):
So it'll be my home.
Congratulations, do you?

have a name picked out.

Speaker 1 (54:07):
We do have a name picked out.
Her name is going to be Mabeland it's after a little lobster
shack in Kennybunkport.
Because we summer in Maine andwhen we pass we walk by Mabel's
all the time and I'm like youknow that's kind of a cute name
and it ties to one of ourfavorite happy places.
So Mabel June, we have a middlename, Scarlata.

(54:31):
Love it.

She needs to make an appearance on this podcast
for sure.

Speaker 1 (54:36):
You know, she will, you know she will All right.

Speaker 2 (54:41):
So I think because of you know just the pace of life,
we keep our challenges going.
We're going to go one moremonth with these challenges
getting outside, eating thatwide variety.
That's going to give us time toimplement more of habit and
ritual with both of ourchallenges.
So again, all of our listeners,we hope that you're joining us

(55:01):
in this challenge and you canleave comments for us on social
about how that's going.
Send us your pictures, engagewith us.
We would love that.
And you know, hey, it's a safespace.
So if you want to let us knowwhat's going on in the toilet,
we're fine with that too.
Let us know.

Speaker 1 (55:15):
Thumbs up, thumbs down, exactly Couple poop emojis
Happy poop or unhappy poop.

Yeah, exactly.

Speaker 2 (55:24):
We hope.
Happy poops, happy poops, yes,okay, so we all poop, and if we
don't talk about it, sometimespeople suffer for decades, and
so we just want you to normalizethis.
Talk with your doctors if youneed to.
And, Dr.
Kinnucan, thank you so much forall of the wealth of
information that you've sharedwith us, and we hope that

(55:48):
everyone learned a lot today,because don't forget proper
pooping position, couple nicedeep breaths and your next
number two could be number onebaby.

Speaker 1 (55:59):
So, Megan, what's up for our next episode?

Speaker 2 (56:03):
Next up it is IBS.
Is it Mimikers?
We're going to talk to Dr BillChey, the chief of
gastroenterology at MichiganMedicine.
He happens to be my boss, amentor, a friend to both of us
and he also wrote the forward ofthat book that I did not pay Dr
Kinnucan throughout our episodetoday.
I did not, she plugged this allon her own, but Dr Chey wrote

(56:24):
the foreword for our book MindYour Gut.
So this is going to be anotherreally fascinating episode where
we get to talk to a really keyopinion leader in this field.
So you will not want to miss it.
To do that, to make sure thatyou don't miss, make sure that
you subscribe and follow and,like The Gut Health Podcast,
leave us a comment in additionto subscribing, and we can't

(56:46):
wait to connect with you nexttime.

Speaker 1 (56:48):
Friends, Absolutely have a great month ahead and
we'll see you soon.
Thanks for having me, guys.
Thanks for coming.

Speaker 2 (56:58):
Thank you for joining us as we grow this Gut Health
community.
We hope you enjoyed thisepisode and don't forget to
subscribe, rate and leave us acomment.
You can also follow us onsocial media at The Gut Health
Podcast, where we'd love for youto share your thoughts,
questions and experiences.
Thanks for tuning in, friends.

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