Speaker 1: Sir, I traversed this day by steamboat the space between
Speaker 1: London and Hungerford Bridges between half past one and two o'clock.
Speaker 1: It was low water, and I think the tide must
Speaker 1: have been near the turn. The appearance and the smell
Speaker 1: of the water forced themselves at once upon my attention.
Speaker 1: The whole of the river was an opaque, pale brown fluid.
Speaker 1: In order to test the degree of opacity, I tore
Speaker 1: up some white card into pieces, moistened them so as
Speaker 1: to make them sink easily below the surface, and then
Speaker 1: dropped some of these pieces into the water at every
Speaker 1: pier the boat came to. Before they had sunk an
Speaker 1: inch below the surface. They were indistinguishable, though the sun
Speaker 1: shone brightly at the time, and when the pieces fell edgeways,
Speaker 1: the lower part was hidden from sight before the upper
Speaker 1: was underwater. Near the bridges, the feculents rolled up in
Speaker 1: clouds so dense that they were visible at the surface
Speaker 1: even in water of this kind. The smell was very
Speaker 1: bad and common to the whole of the water. It
Speaker 1: was the same as that which now comes up from
Speaker 1: the gully holes in the streets. The whole river was,
Speaker 1: for the time a real sewer. Having just returned from
Speaker 1: out of the country air, I was perhaps more affected
Speaker 1: by it than others, But I do not think I
Speaker 1: could have gone on to Lambeth or Chelsea, and I
Speaker 1: was glad to enter the streets for an atmosphere which,
Speaker 1: except near the sinkholes, I found much sweeter than that
Speaker 1: on the river. I have thought it a duty to
Speaker 1: record these facts, that they may be brought to the
Speaker 1: attention of those who exercise power or have responsibility in
Speaker 1: relation to the condition of our river. There is nothing
Speaker 1: figurative in the words I have employed, or any approach
Speaker 1: to exaggeration. They are the simple truth. If there be
Speaker 1: sufficient authority to remove a putrescent pond from the neighborhood
Speaker 1: of a few simple dwellings, surely the river which flows
Speaker 1: so many miles through London ought not to be allowed
Speaker 1: to become a fermenting sewer. The condition in which I
Speaker 1: saw the Thames may perhaps be considered as exceptional, but
Speaker 1: it ought to be an impossible state, instead of which
Speaker 1: I fear it is rapidly becoming the general condition. If
Speaker 1: we neglect this subject, we cannot expect to do so
Speaker 1: with impunity, nor ought we to be surprised if ere
Speaker 1: many years are over, a hot season gives us sad
Speaker 1: proof of the folly of our carelessness. I am, sir,
Speaker 1: your obedient servant. M. Faraday, Royal Institution, July seventh, eighteen
Speaker 1: fifty five.
Speaker 2: There's just so many good parts.
Speaker 3: There's so many good parts, suculents.
Speaker 2: The smell was very bad.
Speaker 3: The smell was very bad.
Speaker 1: Like I have no more synonyms for feculentce and so
Speaker 1: I'm just gonna have to go with the sheer reaction
Speaker 1: of very.
Speaker 3: Bad, very bad, very.
Speaker 2: Bad, I mean. And also this is not an exaggeration. Oh,
Speaker 2: I am not being figurative with it.
Speaker 3: There is no figurative language in this, Sir.
Speaker 2: I love it. I love it so much.
Speaker 3: I love it too.
Speaker 2: I love it.
Speaker 3: I love it. It's ridiculous and it will.
Speaker 1: I will touch more on the specific situation that this
Speaker 1: became the center focus of in this episode.
Speaker 2: I can't wait.
Speaker 1: It's gonna be great. And I already said in the
Speaker 1: first hand where that came from.
Speaker 3: M Fara day There you go.
Speaker 2: Okay, Hi, I'm Aaron Welsh and I'm Aaron Aman update.
Speaker 3: And this is this podcast will kill you.
Speaker 2: Welcome to Poop Part two two.
Speaker 3: Poop number two, number two. We're way too pleased with ourselves.
Speaker 3: But we just think we're so clever we do Okay.
Speaker 1: So, if you have not tuned into the first episode
Speaker 1: in this Poop series, Part two, part series, uh, do it?
Speaker 3: Do it? You know, what are you waiting for?
Speaker 2: Listen to it. You don't have to.
Speaker 1: Listen to it in order, but it will make sense.
Speaker 1: It will still make sense, but you should do it.
Speaker 2: It's a great episode. I'm really proud of it.
Speaker 3: You're going to learn a lot, just like you will
Speaker 3: in this episode.
Speaker 1: So last episode we went over a sort of how
Speaker 1: we make poop and why poop is actually a gold
Speaker 1: mine rather than like the waste that we presently view
Speaker 1: it as. Right, and today we're gonna go over what
Speaker 1: happens when our poop doesn't go to plan right and
Speaker 1: I guess yes, and also why poop is actually gross
Speaker 1: and what we do.
Speaker 2: About it the flip side of the coin.
Speaker 3: You know, poop is many things.
Speaker 2: It is so many things.
Speaker 3: Poop contains multitude.
Speaker 2: It really does it, really truly truly does ed Young
Speaker 2: Thank you. Yeah, it's gonna be a great episode. I'm
Speaker 2: really excited about it. But first at first, it's quarantiny time.
Speaker 3: What are we drinking this week?
Speaker 2: Same thing we drank last week? Drink number two, the
Speaker 2: drink number two. Are actually drinking water, which is also
Speaker 2: important for your poop. But it is you want to
Speaker 2: drink a quarantiny. It's poo number two, it's poop number two,
Speaker 2: it's I drinking number two.
Speaker 3: We keep saying that, Yeah, yeah, yeah, you know, uh
Speaker 3: it's It's basically a chocolate mint. It's great. It's pretty
Speaker 3: easy to make.
Speaker 2: You can do it at home, as you can.
Speaker 3: With all of our quarantines.
Speaker 2: Iway assume we'll post the full recipe for that quarantine
Speaker 2: on our social media channels. Are you following us there?
Speaker 2: Because you should definitely check it out and follow.
Speaker 1: You should You should our website which we may be
Speaker 1: putting quarantini stuff on. Maybe we'll try that out tonight.
Speaker 1: You know, you can find other things though. You can
Speaker 1: find so many things. You can find transcripts, you can
Speaker 1: find links to our bookshop dot org affiliate page, our
Speaker 1: Goodreads list, which needs some updating, links to music by Bloodmobile,
Speaker 1: first hand account form, contact us form sources for each
Speaker 1: and every one of our episodes. It was like I
Speaker 1: know it starts with an S and also YouTube videos.
Speaker 3: You can find links to that.
Speaker 2: Including this one, which we are very excited to be
Speaker 2: bringing you from the Exactly Right Network Studios. Yes, yes, yeah,
Speaker 2: the end, the end.
Speaker 1: Follow us on YouTube, follow us on social media, check
Speaker 1: out our website.
Speaker 3: On the rag, on the rag, what are we?
Speaker 2: Let's just do it.
Speaker 3: Let's just do it. H okay, fantastic. Let's take a
Speaker 3: quick break.
Speaker 2: And then you'll tell us about poop. Sewers, sewers, give
Speaker 2: it to me.
Speaker 3: Okay, poop is gross.
Speaker 2: I love that. That's a sentence that you wrote down upset.
Speaker 3: Yeah. Yeah, I was like, how do I start?
Speaker 2: This is gross?
Speaker 3: Poop is gross.
Speaker 2: It is grody.
Speaker 3: It is it is. There is no getting around it.
Speaker 1: Like, okay, yeah, we can talk about how important it
Speaker 1: is as a resource. We can break it down into
Speaker 1: like what makes up poop? How do we make poop?
Speaker 1: Everyone poops? Pooping is not shameful? Yeah no, I'm behind
Speaker 1: all that. Yeah, the fact remains, poop is.
Speaker 3: Grossss It's gross. After all.
Speaker 1: It can contain pathogens, or it can signal your presence
Speaker 1: to a predator, or it can attract flies that lay
Speaker 1: eggs that hatch maggots. Speaking of which, if you are
Speaker 1: tuning in to the YouTube, we have maggot art.
Speaker 3: We do laid yes, multiple yeah, anyway, yeah, you can
Speaker 3: see it. It's incredible.
Speaker 1: But maggots are also you know, It's just it is what.
Speaker 3: It is, poop.
Speaker 1: The disgust that poop evokes in us is probably evolutionarily
Speaker 1: ingrained because we don't want to be near it, you know.
Speaker 1: It's that it's all again, the pathogens, all that stuff,
Speaker 1: and this aversion that we feel for poop. It's not new, right,
Speaker 1: It's not a product of our modern sanitation system or
Speaker 1: like a remnant of prudish Victorian sensibilities. It's yeah, right,
Speaker 1: it's not just like it is.
Speaker 3: It is normal to feel disgusted by poop.
Speaker 2: Okay.
Speaker 1: Charles Darwin even called disgust one of the six universal
Speaker 1: universal emotions.
Speaker 2: Oh that's so.
Speaker 1: And this disgust for poop it's not specific to humans.
Speaker 1: Many animals go out of their way to avoid poop,
Speaker 1: like having designated latrines far away from their burrows, or
Speaker 1: grazing only in areas uncontaminated by poop. This was a
Speaker 1: real issue in Australia after the poop calcul accounted. Yeah,
Speaker 1: because they were like, I'm not I'm not eating million
Speaker 1: tons right, yes, yes, every year.
Speaker 3: Yea.
Speaker 1: For much of human history, poop didn't pose too much
Speaker 1: of a logistical issue for humans, right. We were living
Speaker 1: in small groups, we were moving around a bunch. It
Speaker 1: was a simple matter to just like, oh, the you know,
Speaker 1: the call of nature, and you just take a little step.
Speaker 2: Away from the grow away you poop.
Speaker 1: Oh actually you didn't go away from the necessarily. Yeah,
Speaker 1: but it wouldn't.
Speaker 2: Have mattered all that much because you were going to
Speaker 2: move on. You were going to move someone else's problems.
Speaker 3: Yep.
Speaker 1: And that is how giardia is everywhere, and now it's
Speaker 1: all of our problem. But yeah, so and also in
Speaker 1: addition to like it not being a huge issue in
Speaker 1: terms of like having to constantly be around your own poop,
Speaker 1: you're moving on, and our poop was an essential part
Speaker 1: of that nutrient cycle and seed dispersal.
Speaker 3: You know, you eat some berries here, you walk for
Speaker 3: a while, you poop over there. Now you got a
Speaker 3: newberry bush. Yeah.
Speaker 1: And then it was also not just seeds for you know,
Speaker 1: berry plants. It was also we're providing material for decomposers
Speaker 1: we're fertilizing the ground. It's the typical circle of poop
Speaker 1: like we talked about. But then, of course humans begin
Speaker 1: to live in larger groups and for longer periods. We
Speaker 1: developed agriculture, we bred livestock, we built permanent settlements, and
Speaker 1: poop became a problem.
Speaker 2: Yeah.
Speaker 1: We used as much as we could to fertilize crops
Speaker 1: aka night soil. We dug poop pits on the fringes
Speaker 1: of our settlements. We designated communal pooping areas. We pooped
Speaker 1: on riverbanks and near stream so that the water would
Speaker 1: wash the pool away and out of sight. But every
Speaker 1: fix proved to be a temporary one. As human populations
Speaker 1: grew and grew, pit toilets filled to the brim, poop
Speaker 1: shoots didn't always extend to the cesspit that collected sewage.
Speaker 2: Sorry, sorry, sorry, A poop shoots a real thing? Is that?
Speaker 3: It technical that I don't know. I was just imagining
Speaker 3: like a tube, you know, what they use for construction exactly.
Speaker 2: I always thought your poop shoot was your butt.
Speaker 3: Well yeah, I think that that's like the idea of
Speaker 3: a multiple meanings shoot.
Speaker 2: Like that was a thing they really had.
Speaker 3: I mean, there were I'll get into it, okay.
Speaker 1: But yes, there were pipes more or less that you know,
Speaker 1: or they would be uncovered essentially gutters gutters, poop gutters,
Speaker 1: but poop shoot just sounds better.
Speaker 2: I love it.
Speaker 3: Yeah.
Speaker 1: And then there were indoor chamber pots that required frequent
Speaker 1: emptying at locations not within a quiet or a quick walk.
Speaker 3: You know.
Speaker 1: This was there were a lot of different ways that
Speaker 1: poop just you can't. You turn your back and suddenly
Speaker 1: there's a massive.
Speaker 2: Pilot's another that you have to do. Of course. Yeah,
Speaker 2: it's just like laundry.
Speaker 3: Okay, So it is. I'm like, dais it is just
Speaker 3: like laundry. Okay.
Speaker 1: So to put the poop overload into perspective, let's consider Canosos,
Speaker 1: which is the largest city of the Minoan civilization, older
Speaker 1: than ancient Greece, located on the island of Crete. Around
Speaker 1: its peak, say seventeen hundred BCE, there were one hundred
Speaker 1: thousand people.
Speaker 3: Living in Canosis, each pooping every.
Speaker 1: Day, of course, well on average, for a total of
Speaker 1: fifty tons of poop per day.
Speaker 3: Wow, that's a lot of poops.
Speaker 1: Even in seventeen hundred BCE, that's a lot of poopy
Speaker 1: and it, of course, pales in comparison to what the
Speaker 1: city of New York makes in a single day today.
Speaker 1: And I singled out New York because that is where
Speaker 1: the data are available. Okay, so poop and pee combined
Speaker 1: to about twelve hundred tons or two point for million
Speaker 1: pounds daily, every day, every.
Speaker 2: Day, two point four million pounds of waste from our bodies.
Speaker 3: Does it waste? Though, Aaron, I thought we learned that
Speaker 3: it wasn't.
Speaker 2: It's a synonym for poop and pea, turds, turds and p.
Speaker 2: We can't forget pee, we can't forget the p.
Speaker 1: Yeah, it's a substantial portion, is yeah, Okay, so it's
Speaker 1: it's it's not New York today, but you could you
Speaker 1: could see why it would quickly become a pressing matter
Speaker 1: immediately an effective solution for the minoans.
Speaker 3: That solution turned out to be water.
Speaker 1: A handful of engineering minded individuals realized the power of
Speaker 1: water as transportation, and they devised water supply systems that
Speaker 1: piped in rain water to flush toilets toilets.
Speaker 2: They had flushing toilets in seventeen hundred BC.
Speaker 1: Yeah, wow, I mean so the toilets were pretty much
Speaker 1: like localized to the Minoan civilization. Okay, And but they
Speaker 1: were not just in palaces, like they started out just
Speaker 1: in palace. But yeah, I mean, and it wasn't like
Speaker 1: continuous supply. You had to you know, dump in you've
Speaker 1: ever been somewhere, you had to dump in waters to
Speaker 1: the top.
Speaker 3: Yeah, it's like that.
Speaker 2: Wow, that's so cool. And then they had pipes, I mean.
Speaker 1: And also the seats were like really wooded and splintery looking.
Speaker 2: For sure, I mean, where did the poop go?
Speaker 1: Okay, So the water flushed the poop out of the
Speaker 1: building and down into the sewers that ran into the
Speaker 1: streams that ran into the sea.
Speaker 2: So it was all just sort of like connect yep.
Speaker 1: And since then the world has never been the same.
Speaker 3: Wow.
Speaker 1: And remarkably, four thousand years later, those drains still function
Speaker 1: perfectly after a large rain shower.
Speaker 2: Are you serious?
Speaker 3: They still wash? They still washed right down like to
Speaker 3: the streams to the sea. Yeah.
Speaker 1: For thousands of years now, though, we have used water
Speaker 1: to do our dirty work, separating us from the poo
Speaker 1: that we produce, so that we don't have to look
Speaker 1: at it or smell it or have it contaminate the
Speaker 1: water that we use the invention of flush toilets and sewers,
Speaker 1: which were all we'll talk about the modern flush toilet,
Speaker 1: because this wasn't one that was like, this.
Speaker 3: Didn't go everywhere. Yeah, exactly.
Speaker 1: They has saved countless lives and it has made our
Speaker 1: day to days much more pleasant. Right, But in allowing
Speaker 1: us to flush and forget, we have become divorced from
Speaker 1: the reality of poop, not as a waste product, but
Speaker 1: again as a resource.
Speaker 3: From those first splintery.
Speaker 1: Wooden Minoan toilets to the seat warming, water spraying high
Speaker 1: tech toilets of today, we've been moving poop from here
Speaker 1: to way over there, radically upsetting the balance of nutrients
Speaker 1: like phosphorus and nitrogen across the landscape. And just as
Speaker 1: the early Minoans confronted the mounting poop problem in their
Speaker 1: city and devised a solution, we finally seem to be
Speaker 1: coming to terms with the fact that it's time for
Speaker 1: a new solution, or a suite of solutions to contend
Speaker 1: with our growing poop issue, our cacatastrophe.
Speaker 2: I can't let that one good it was in the
Speaker 2: moment it was it was.
Speaker 1: We have proof of that. We didn't take a break,
Speaker 1: and then edit that out brain store. Now it sounds
Speaker 1: like we did, but we really didn't. So what I
Speaker 1: want to do now is take us through how we've
Speaker 1: dealt with our poo and pee and other liquid waste
Speaker 1: throughout history, and how a change in how we think
Speaker 1: of and deal with poop is really the only path forward.
Speaker 1: The Minoans were not the first or the only group
Speaker 1: in the ancient world to devise ways to manage the
Speaker 1: sewage that was produced in large cities. Around the same time,
Speaker 1: the harapan civilization in what is now India also had
Speaker 1: a similar drainage system using deep gutters which with removable
Speaker 1: covers so you could like get rid of any yeah,
Speaker 1: exactly connected from house to house, similar to the way
Speaker 1: that many of our modern drainage systems work today.
Speaker 3: Yeah.
Speaker 1: And so for cities that numbered in the tens of thousands,
Speaker 1: these Minoan and Harappan sewage systems they did a decent job,
Speaker 1: no doubt. Things were still stinky, especially if there wasn't
Speaker 1: a lot of rainfall, and like cesspits probably got clogged,
Speaker 1: but it did all right considering Yeah, Unfortunately, they were
Speaker 1: no match for the more than one million occupants of
Speaker 1: ancient Rome. I mean really, the history of sewage systems
Speaker 1: and poop comes down to like, oh no, there's too
Speaker 1: much poop. Oh we fixed it. Oh no, there's too
Speaker 1: much poop again. Oh we fixed it again. Oh no,
Speaker 1: you know, it's just like risky forever forever. Yeah, okay,
Speaker 1: So how did ancient Romans fix it? With something called
Speaker 1: the kloaca maxima cloaka.
Speaker 2: That's a great word.
Speaker 1: It is a great word, Okay, cloaca maxima.
Speaker 2: I know, because like I feel like we should define
Speaker 2: because some people might know.
Speaker 3: Yeah yeah, yeah, no, I mean we could.
Speaker 1: So my first exposure to the word kloaca came from
Speaker 1: what we use it, the biological term meaning the single
Speaker 1: orifice through which many animals do all their business pe
Speaker 1: reproduce kloaca. That usage only came into existence in like
Speaker 1: the eighteen hundreds, So the word kloaca existed before then,
Speaker 1: and it was it translated. It was basically translates into
Speaker 1: the word sewer. So kloaca maxima greatest sewer, greatest sewer
Speaker 1: of meaning like the biggest largest.
Speaker 2: I love imagining ancient.
Speaker 3: It's like very in line with how I think about
Speaker 3: ancient Roman much.
Speaker 1: Yeah, Okay, but Kloaca comes from the Roman goddess Cloacina.
Speaker 3: Based on the word to clean. Oh so it has
Speaker 3: sewer clean yeah, yeah, so yeah, the Kloaca Maxima, it
Speaker 3: really did live up to its name though in terms
Speaker 3: of its size. It was so big that entire wagons
Speaker 3: filled with could travel through it.
Speaker 2: It was mess so it's like storm drain like rivers
Speaker 2: that we have here in southern California today, like like those.
Speaker 1: Like you could take a boat, like a small boat
Speaker 1: throughout it. Wow, isn't that amazing?
Speaker 2: It was just for sewage.
Speaker 1: It was just well no, actually, so every day it
Speaker 1: would handle a lot millions of gallons of water and
Speaker 1: a million pounds of poop probably flowed through the Chloaca
Speaker 1: Maxima every day, something around there. But like our sewer
Speaker 1: systems of today, it was not created necessarily to just
Speaker 1: handle human waste. It was mostly to prevent to remove
Speaker 1: excess water during a rainstorm. And Rome was built on
Speaker 1: a swamp.
Speaker 3: Basically, it's the Houston of the ancient world.
Speaker 2: Thank Houston. Someone's gonna get real mad about that.
Speaker 3: Houston is not a swamp.
Speaker 1: Yes, I know that, Okay, just dating facts here. It's
Speaker 1: true and so you have to drain. You have to
Speaker 1: drain the swamps to prevent flooding, and so that is
Speaker 1: what with the Kloaca Maxima also did. It was mostly
Speaker 1: to just drain the swamp. I don't know why this
Speaker 1: is so funny, but it really is. But the Chloaca Maxima,
Speaker 1: I'm just going to say it as many times as possible,
Speaker 1: was an engineering marvel, and the Romans poured money into
Speaker 1: its construction and its upkeep. It was a real like uh,
Speaker 1: it's a real testament to how much they cared about
Speaker 1: sewage and sewer systems. Is that the Chloaca Maxima, parts
Speaker 1: of it are still standing where many, many, many other
Speaker 1: buildings have fallen.
Speaker 2: But they were like this, this should stand.
Speaker 1: Yes, okay, do you want to hear more about what
Speaker 1: the toilet experience might have been like for someone in an
Speaker 1: ancient room?
Speaker 2: Of course?
Speaker 1: All right, So if you're wealthy, you would have your
Speaker 1: own private latrine in your big house, likely situated over
Speaker 1: a dugout pit. Or you'd be like, no, I'm going
Speaker 1: to get a chamber pot and have someone just get that.
Speaker 2: Get away from more.
Speaker 1: I don't want even this in my pay my house
Speaker 1: to do that okay, pay someone nothing. Many wealthy citizens
Speaker 1: didn't want to care neck to their house to the
Speaker 1: Chloeica maxima because the smell it wasn't Also like there
Speaker 1: wasn't water piping continuously through.
Speaker 2: Okay, and so you kind of it wasn't sunk.
Speaker 1: Things just would have hung out there and then vermin. Yeah,
Speaker 1: you know it's I get it. So but they were
Speaker 1: really the only people to enjoy privacy while pooping were
Speaker 1: the wealthy.
Speaker 3: Everyone else that it was a luxury for them.
Speaker 1: Public toilets were constructed, used almost exclusively by men. It
Speaker 1: was not a safe place for women. They were found
Speaker 1: throughout the city, paid for often by the wealthier citizens
Speaker 1: who wanted to avoid poop in the streets.
Speaker 3: And that happened all the time in the streets.
Speaker 1: Yeah, there are so many inscriptions warning people against pooping
Speaker 1: in this alley or against this building or whatever. So
Speaker 1: there's one found in POMPEII that warned, quote, defecator, watch
Speaker 1: out for what might happen to you.
Speaker 3: In an alley in an alley, stop pooping here, defcator, defecator.
Speaker 3: If you if you poop, you will be by the way.
Speaker 2: Yeah, we should call more people.
Speaker 3: Everyone is a deficator.
Speaker 2: That's true. What we use it as a disc feels intentional.
Speaker 3: It does, it does. Okay.
Speaker 1: So these these public toilets were housed under a low
Speaker 1: ceiling with small windows, so like not a very pleasant,
Speaker 1: you know, place to be. And they were essentially marble
Speaker 1: benches carved with rows of holes, just roll whole after
Speaker 1: hole after hole, no dividers between the holes, so close
Speaker 1: that you could hold hands, you could carry on a
Speaker 1: whispered conversation or make after work plans with your pooping partner.
Speaker 1: People weren't really wearing pants. It was more like a
Speaker 1: toga vibe situation as far as I read, you know,
Speaker 1: I don't know how widespread togas worth. That's just like
Speaker 1: my image of ancient room. But you weren't totally exposed,
Speaker 1: so like you weren't dropping trout.
Speaker 2: The way that you would be today. Yeah, okay.
Speaker 1: And so for wiping your heine, there were which I
Speaker 1: I love wiping heiney is another great word for wiping
Speaker 1: your heney. There were communal communal sea sponges on a
Speaker 1: stick were called tersorium or wiping thing.
Speaker 3: Yeah.
Speaker 2: So they just was like a few of them scattered about.
Speaker 2: I don't know, what.
Speaker 1: I don't know the numeor yeah, I don't know how
Speaker 1: many there were.
Speaker 2: Was there like water, Yes, there was a bucket of water.
Speaker 1: There was a gutter of clean water to clean the
Speaker 1: sponge in between uses.
Speaker 2: Okay, a sea sponge. That's actually genius, it is. Yeah,
Speaker 2: I mean I love it.
Speaker 1: I don't know if I love it. The commune, it's
Speaker 1: the communal part that really gets to me. Yeah, And
Speaker 1: whether there was hand washing, probably not. It doesn't seem
Speaker 1: to be, so who knows. You can, like, let me check, right, yeah,
Speaker 1: let me but know. But okay, So the poop and
Speaker 1: pea would flow from these public toilets away into a
Speaker 1: sewer system where they eventually emptied into the river Tiber,
Speaker 1: which is also where people got their drinking and bathing water.
Speaker 1: The filth might have been out of sight, out of mind,
Speaker 1: but it didn't mean it wasn't an issue.
Speaker 3: There was water borne illness all over the place.
Speaker 1: It was, I mean, based on descriptions, like it seemed
Speaker 1: pretty pretty overrun with poop and pea, and there was
Speaker 1: a lot of like issues related to disease because of that. Yes, okay,
Speaker 1: So moving on from ancient Rome, though throughout the medieval
Speaker 1: period and beyond, sewage construction in most of Europe was
Speaker 1: guided by the get this poop as far away from
Speaker 1: me as possible principle. Livestock manure was spread on fields
Speaker 1: for fertilization, and toilets operated under a similar logic as
Speaker 1: an ancient Rome, not the Minoan civilization, minus the chloaca
Speaker 1: maxima that effectively more or less effectively drained things away,
Speaker 1: so there would be like outdoor latrines for the poor,
Speaker 1: you know, pits or barrels, which could then be like
Speaker 1: buried or taken away, while the rich built private toilet
Speaker 1: rooms in their castles where they like stuck out over
Speaker 1: the moat so that the poop and pea would travel
Speaker 1: down a shoot into the water.
Speaker 2: A poop shoot, poop shoot. This that always makes me
Speaker 2: think of the Game of Thrones, the guy who died
Speaker 2: on the toilet. There was anyways, it doesn't matter, but
Speaker 2: there was a guy who died on the toilet. He
Speaker 2: got shot with like an arrow in the toilet, and
Speaker 2: his toilet room was like way up and off away
Speaker 2: in the castle. Just was like historically accurate. Just might
Speaker 2: it not be an historical show?
Speaker 3: But no, I mean that that I think that is.
Speaker 1: That's what I'm sort of imagining, these little rooms like
Speaker 1: just to sort of cut out and then like boop, yeah, okay,
Speaker 1: cool into the surrounding moat.
Speaker 3: So like it just would just be poop or in
Speaker 3: the moat, just feeding.
Speaker 2: The crocodiles or whatever.
Speaker 1: Feeding something of the carp and catfish, I don't know, uh.
Speaker 1: And so that's where it would stay until like the
Speaker 1: rains grew heavy enough and then the currents could.
Speaker 3: Carry it away.
Speaker 2: Okay, okay.
Speaker 1: So as European cities exploded in population, the situation.
Speaker 3: Grew dire and more diers. It does, poop piled up.
Speaker 1: Multiple laws were passed like this is how bad the
Speaker 1: poop was, right, There were many laws in many countries
Speaker 1: about public pooping. They were trying to regulate how much
Speaker 1: poop there was on the streets. So, for instance, in Berlin,
Speaker 1: a sixteen seventy one law was passed that instructed every
Speaker 1: peasant visiting Saint Peter's Church to.
Speaker 3: Take a pile of poop away. It was a popular
Speaker 3: dumping ground, so many.
Speaker 2: People would poop there. It was like you need to take.
Speaker 3: Take you to take poop away? Yeah, fascinating, I know.
Speaker 1: In fifteen thirty one, a law in Paris required landlords
Speaker 1: to provide a latrine for every house.
Speaker 2: Wow. Not until fifteen thirty.
Speaker 3: One, Yeah, were the laws enforced.
Speaker 1: That Many people did their business in chamber pots in
Speaker 1: their home, which they then emptied out of the window
Speaker 1: after a yelled warning like look out the Yeah. The
Speaker 1: descriptions of people pooping every where in the streets or alleys,
Speaker 1: and waste piled high, like there are many of them,
Speaker 1: but there it's it's too much, okay. For example, quote,
Speaker 1: the louver was a mess. People defecated without restraint or
Speaker 1: attempt at secrecy in the courtyards, on the stairs and balconies,
Speaker 1: and behind doors, without hindrance from palace attendants. On August eighth,
Speaker 1: sixteen oh six, an order was given prohibiting any resident
Speaker 1: of the Palace of Saint Germain from committing a nuisance
Speaker 1: Therein that same day, the King's son urinated against the
Speaker 1: wall of his room.
Speaker 3: End quote. So like people just seem to be pooping everywhere.
Speaker 2: That is so fascinating to me.
Speaker 3: It is to me too, I don't know how.
Speaker 2: Yes, that's like you just I mean, I guess if
Speaker 2: you don't really have an alternative, right, If you don't
Speaker 2: have an alternative, you got to go nature calls.
Speaker 1: In nature calls and so it's like and the laws
Speaker 1: were not effective, and it just kind of of course,
Speaker 1: the problem keeps growing. But keeping in the theme with
Speaker 1: one man's trash is another's treasure, there was an entire
Speaker 1: occupation that sprung out from these soiled streets, the so
Speaker 1: called nightmen oh okay so also known as scavengers.
Speaker 3: These nightmen would walk the streets at night.
Speaker 1: They would empty out chamber pots and public toilets to
Speaker 1: either sell to farmers or just dump in the countryside.
Speaker 1: They would be like, I will handle your waiste. People
Speaker 1: had like signs on like carriages or like wagons that
Speaker 1: were like I am the best at this. I will
Speaker 1: make sure it's love to do this.
Speaker 3: Yeah, yeah.
Speaker 1: And when transport became a challenge, like there was just
Speaker 1: too much to carry or whatever, they dug out big
Speaker 1: pits and they held the waist there. And this is
Speaker 1: when they began to experiment with different chemicals and other
Speaker 1: additives to dissipate the smell, or they would heat the
Speaker 1: night soil to desiccate it.
Speaker 3: But guess what happened, Darren.
Speaker 2: Something bad.
Speaker 3: I mean kind of just populations keep growing and too
Speaker 3: much kept growing, and the nightmen just couldn't keep up,
Speaker 3: and so the situation was again becoming dire.
Speaker 1: Fortunately a hero was about to emerge. Ajax the first
Speaker 1: modern flushing toilet. Oh, it was invented by Sir John Harrington.
Speaker 3: Ajax was the name. He gave it.
Speaker 1: Yeah, yeah, in England fifteen eighty four, after being sent
Speaker 1: away by the Queen, whom he offended with his poetry.
Speaker 3: It's true story. No one knows the exact details, but
Speaker 3: like I can imagine, the gossip.
Speaker 1: Was just what did he say this time? But he
Speaker 1: embarked on some home construction projects and out of this
Speaker 1: creative retreat sprung the toilet. And it wasn't the first,
Speaker 1: like I mentioned, the Manoans and Harrappans hold that title,
Speaker 1: but it did involve a more advanced flushing system with
Speaker 1: valves and a sistern kind of like what we think
Speaker 1: of today where.
Speaker 3: It has that on top. And then yeah, he named
Speaker 3: it Ajax.
Speaker 1: And wrote an ode in its honor, and then the Queen,
Speaker 1: after getting over her irritation towards him, she visited. She
Speaker 1: tried it out and she was like I I need
Speaker 1: one of these, so she had one built in her palace, home, castle,
Speaker 1: whatever it was, whatever it is. Over the next couple
Speaker 1: of centuries, the toilet underwent several technological improvements that made
Speaker 1: it more feasible to be installed in lots of homes,
Speaker 1: and soon everyone it was like, I need this, I
Speaker 1: want a standard part of your home. Its popularity was
Speaker 1: helped along by British plumber Thomas Crapper, who did not
Speaker 1: invent the toilet nor give his name to a slang
Speaker 1: word for poop like his name really yeah, but he
Speaker 1: did a great job at marketing it, and he kind
Speaker 1: of helped to turn the toilet into a status symbol.
Speaker 3: Everyone wanted one for him.
Speaker 2: I want a Crapper, I mean yeah.
Speaker 3: And guess what happened.
Speaker 1: People were so happy to flush and forget and the
Speaker 1: problem of excess poop was solved for a.
Speaker 3: Very brief period of time.
Speaker 1: What the toilet had effectively done was move those individual
Speaker 1: cesspits from the home to the rivers that supplied the
Speaker 1: city with water, making one giant cesspit out of it.
Speaker 3: The situation again grew dire.
Speaker 1: How dire you might ask, Let's go to London eighteen
Speaker 1: fifty eight for the full picture.
Speaker 3: Okay, that summer was.
Speaker 1: Unusually hot and dry, but any enjoyment of sunny weather
Speaker 1: was thwarted by the shocking stench that emanated from the Thames.
Speaker 1: I've mentioned the Great Stink of eighteen fifty eight before
Speaker 1: in our Typhoid Fever episode, and I read a quote
Speaker 1: in that episode that I think is worth dredging up
Speaker 1: for this one. Okay, this is from a newspaper reporting
Speaker 1: on the Great Stink. Quote, for the first time in
Speaker 1: the history of men, the sewage of nearly three million
Speaker 1: people had been brought to seethe and ferment under a
Speaker 1: burning sun in one vast open kloeca, lying in their midst.
Speaker 2: I remember this quote now because we made it into
Speaker 2: a reel. It's like one of our first reels that
Speaker 2: we ever made.
Speaker 3: I don't know why. It just kills me.
Speaker 1: And it's like it is the word kloka, but it's
Speaker 1: also like poetic in a way.
Speaker 2: It is it's beautiful and disgusting.
Speaker 1: Disgusting, it's really effective. It is that is effective language,
Speaker 1: right there. Uh So, Okay, the times had been getting
Speaker 1: more disgusting for years, but the Great Stink really galvanized
Speaker 1: many Londoners. Something had to be done about this, not
Speaker 1: just because of the unpleasantness of having to breathe that
Speaker 1: vile air, but also because that air was thought to
Speaker 1: spread disease. My asthma was sort of the leading idea
Speaker 1: at the time, And it wasn't the air itself, but
Speaker 1: it certainly was the water, as John Snow revealed in
Speaker 1: his investigations of the London caller outbreaks from a few
Speaker 1: years before, which was of course caused by the nasty
Speaker 1: and poorly functioning drainage systems in the city. Those color outbreaks.
Speaker 1: So it took a few decades. I'm skipping over so
Speaker 1: much here in terms of like the history of sewage,
Speaker 1: but eventually a massive and intricate sewer system was built
Speaker 1: to manage London's waste. The project was spearheaded by visionary
Speaker 1: engineer Joseph Basilget, and the completed system, truly a modern marvel,
Speaker 1: still serves the city today.
Speaker 2: Wow.
Speaker 3: And there's a.
Speaker 1: Whole book about its design and basil Get and the
Speaker 1: Great Stink if you'd like to learn more, it's on
Speaker 1: one of these shelves here. The London sewer system, which
Speaker 1: acted as inspiration for many other cities. It operates with
Speaker 1: the goal of using water to wash away the city's
Speaker 1: poop and liquid waste, and in the brainstorming phase of
Speaker 1: this design, several options were presented and dismissed before landing
Speaker 1: on this present layout. One of these ideas involved transporting
Speaker 1: the waste to farms in the surrounding countryside to use
Speaker 1: as fertilizer andn youual value. A four million people's excrement,
Speaker 1: which is in the city of London was estimated to
Speaker 1: be about worth about one point seven million pounds in
Speaker 1: the eighteen eightiesh which is one hundred and seventy eight
Speaker 1: million pounds today.
Speaker 3: Oh wow in terms of fertilizer yep.
Speaker 1: But England, not seeing the tremendous worth of this substance,
Speaker 1: opted to flush it away, a strategy in keeping with
Speaker 1: the sentiment of past centuries that poop was waste and
Speaker 1: nothing more, and this sentiment wasn't universally shared even across Europe.
Speaker 1: In his book Lemiz, Victor Hugo question question to the
Speaker 1: similar approach that Paris took with its sewers, quote, what
Speaker 1: do we do with all this golden dung? It is
Speaker 1: swept into an abyss? All the human and animal manure
Speaker 1: which the world wastes, if returned to the land instead
Speaker 1: of thrown into the sea, would suffice to nourish the
Speaker 1: world end quote.
Speaker 3: Truth.
Speaker 2: Yeah, he's not wrong, truth.
Speaker 1: And he wasn't just discussing a hypothetical strategy. For millennia,
Speaker 1: many cltures had a much different perspective on how best
Speaker 1: to deal with the amount of poop and pea that
Speaker 1: a growing city produced. Where the ancient Romans and modern
Speaker 1: Londoners saw the value of poop in its absence, other
Speaker 1: cultures saw its value as a fertilizer. Why did some
Speaker 1: parts of the world adopt the view of human excrement
Speaker 1: as a valuable thing and others as a thing to
Speaker 1: get as far away from as possible. One aspect was
Speaker 1: need how many livestock you had, or how fertile your
Speaker 1: soil already was, or how much pasture land was even available.
Speaker 1: Maybe you were land limited, right, you couldn't just clear
Speaker 1: more land when all the nutrients were leached out of
Speaker 1: your soil. Or maybe you didn't have and didn't have
Speaker 1: the land to have at these ample amounts of livestock
Speaker 1: that were producing manure that could be used as fertilizer,
Speaker 1: and so you're just like, I'm going to use what's
Speaker 1: right in front of me. This is fertilizer.
Speaker 2: I'm already making it.
Speaker 3: Yeah.
Speaker 2: Yeah.
Speaker 1: Throughout Japan's history, for instance, both poop and urine was
Speaker 1: sold to farmers to fertilize their crops called knights. Japan
Speaker 1: didn't really have acres and acres of pasture land or
Speaker 1: many large livestock, and so night soil was highly valued.
Speaker 1: If you rented an apartment, your landlord technically owned the
Speaker 1: night soil that you produced, and so the rent was
Speaker 1: adjusted based on the number of people living in a room.
Speaker 2: How many people are pooping here?
Speaker 1: Yeah, how much can I get for their poop? So
Speaker 1: if five people lived in one room, rent was free.
Speaker 3: For example, Yeah, that's hilarious.
Speaker 1: Pooping at a friend's house was considered a generous act
Speaker 1: because you're like, thank you for that.
Speaker 2: Oh my god, I love that.
Speaker 3: I know.
Speaker 1: So you might wonder how this practice, which the use
Speaker 1: of night soil is still used in many parts around
Speaker 1: the world today, how it didn't lead to the spread
Speaker 1: of pathogens transmitted by poop. You know, we just talked
Speaker 1: about the Great stink and colera outbreaks. And all of that,
Speaker 1: and a big part of it was how you process
Speaker 1: the poop composting, right, you have to what is the
Speaker 1: word ferment, ferment the poop, I guess, And so this
Speaker 1: what would happen is like in this composting process, it
Speaker 1: would help to reduce the proliferation of pathogenic bacteria in
Speaker 1: the poop and break it down into its raw components,
Speaker 1: which were more readily used by plants. It's a part
Speaker 1: of the decompositions like right, you know. And the second
Speaker 1: was just like standard hygienic practices, washing hands, boiling water,
Speaker 1: cooking vegetables, things like that. Japan wasn't alone in seeing
Speaker 1: the value of night soil. China was also well ahead
Speaker 1: of the curve when it came to seeing poop as
Speaker 1: a resource rather than waste. One strategy that people used
Speaker 1: in China was to let all the refuse from humans, animals,
Speaker 1: other parts of agriculture all mixed together with water in
Speaker 1: covered tubs and pits, and then after the fermentation process
Speaker 1: was complete, they would either pour this liquid maneuver directly
Speaker 1: onto the roots or let it dry in the sun,
Speaker 1: forming cakes which would desiccate, and then they could sell
Speaker 1: yeah mix with water, and there's instant fertilizer. Poop was
Speaker 1: so valued that in seventeen thirty seven in China there
Speaker 1: was an imperial treatise that commanded treasure night soil as
Speaker 1: if it were gold.
Speaker 2: Wow. Yeah, seventeen hundreds.
Speaker 1: You said, seventeen hundreds for that, But it had been
Speaker 1: going on for much longer.
Speaker 3: Yeah.
Speaker 1: And so while most of Europe treated poop as a
Speaker 1: waste product exclusively, there were a few pockets that saw
Speaker 1: it differently, some places that paid for poop rather than
Speaker 1: paying to have it be taken away. In parts of
Speaker 1: Belgium and in the Netherlands, farmers utilized night soil for
Speaker 1: crop fertilization. They constructed specialized casks that could hold over
Speaker 1: one hundred gallons. The casks were loaded onto carts where
Speaker 1: they were dragged around by a horse, the farmer on
Speaker 1: the horse lifting the rope that controlled the lever to
Speaker 1: be like now reallyaseam now really some more.
Speaker 3: It's pretty ingenious.
Speaker 1: And even in the US in the late eighteen hundreds
Speaker 1: there was a very successful night soil company based in
Speaker 1: New Jersey who got paid twice for their labor, first
Speaker 1: to remove the poop in the first place, and then
Speaker 1: the second to sell fertilizer, and so inspired by their success,
Speaker 1: a few sewage farms sprung up around the US, but
Speaker 1: eventually they fell out of favor by the end of
Speaker 1: the nineteenth century, as did night soil almost across the board.
Speaker 1: What changed the invention of commercial fertilizer and the introduction
Speaker 1: of germ theory, whereby poop became the enemy and nothing more.
Speaker 1: And I think it's important to note, and I feel
Speaker 1: like we didn't cover this in an actual episode, like
Speaker 1: a regular episode, but in a there was The Devil's
Speaker 1: The Devil's Element Book club book.
Speaker 3: He talked about fertilizer.
Speaker 1: And like guano, these islands of guano, and then people
Speaker 1: harvesting like bones from battlefields, like old battlefields to use
Speaker 1: his fertilizer. And I just find that so because a
Speaker 1: lot of that was happening in like the eighteen hundreds
Speaker 1: or so, and there was this huge rush prior to
Speaker 1: the introduction of commercial fertilizer, and poop was there all along, right,
Speaker 1: It's just yeah.
Speaker 2: It is really really interesting, right, especially to think about
Speaker 2: that alongside the rise of germ theory, which like we
Speaker 2: talk about so much on this podcast, and it is
Speaker 2: like so important, and your poop can make you quite sick,
Speaker 2: and so it's it is just really interesting to think
Speaker 2: of those things as like side by side and like
Speaker 2: how yeah.
Speaker 3: Wait to see it in one like one one angle right.
Speaker 1: One perspective of poop is just that it is waste
Speaker 1: and nothing more in the enemy, and it's going to
Speaker 1: make you sick, and that's it, and that is true.
Speaker 2: It is true, and two things can be true.
Speaker 1: But what have so that when these when these things change,
Speaker 1: the introduction of commercial fertilizer and then germ theory things,
Speaker 1: even places that had long used night soil, it just
Speaker 1: they kind of stopped, like many places stopped. Commercial fertilizer
Speaker 1: took over in the twentieth century, and that decree of
Speaker 1: treasure night soil, if it were gold, became a relic.
Speaker 3: Of the past.
Speaker 1: Poop was no longer a commodity. It was a thing
Speaker 1: to rid yourself of, a thing to fear, and today
Speaker 1: most of the world is still stuck in that mentality,
Speaker 1: though really we should be following that eighteenth century decree
Speaker 1: because it is wild how much waste we let.
Speaker 3: Go to waste.
Speaker 1: Functioning sewage systems are foundational to public health, and everyone
Speaker 1: should have access to clean water because water borne disease
Speaker 1: kills so many people every year. But it's also clear
Speaker 1: that our massive sewage plants have solved one big problem
Speaker 1: removal of poop from our immediate proximity, while simultaneously creating another,
Speaker 1: too much poop in all the wrong places. We raise
Speaker 1: livestock on large scale farms, where their manure leaches into
Speaker 1: the waterways near the farms. Meat and other food gets
Speaker 1: shipped to our local stores, removing those nutrients from where
Speaker 1: they were grown. Then we eat the food and poop
Speaker 1: it out, and that gets flushed into waterways, again far
Speaker 1: from the original source of these nutrients, and.
Speaker 2: Then it goes into the ocean, goes.
Speaker 1: Into algal blooms, marsh decay, barren farmland, eroding soil's ecosystem
Speaker 1: collapse Like these are the consequences of nutrient redistribution across
Speaker 1: the landscape.
Speaker 3: Oh man, this situation is again becoming dire. What do
Speaker 3: we do about it? This time?
Speaker 2: I have an answer?
Speaker 1: I don't I mean, I don't have an answer personally.
Speaker 1: But there are so many people, so many people who
Speaker 1: are working on this problem from many, many different angles.
Speaker 1: They're designing more efficient toilets, revisiting the idea of sewage farms,
Speaker 1: transforming human waste into fuel or fertilizer, even just rebranding
Speaker 1: poop into something that's like not shameful. Props to the
Speaker 1: poop emoji for that one. It doesn't mean it's like
Speaker 1: it's really funny. It's like a very popular emoji. It's
Speaker 1: a great emoji.
Speaker 3: Yeah.
Speaker 1: And it doesn't mean like there are many people working
Speaker 1: on this, and it doesn't mean that we have everything
Speaker 1: under control right now, but we do have possible paths
Speaker 1: forward and a ton of amazing innovators that are dedicated
Speaker 1: to this work and.
Speaker 3: Really passionate about it.
Speaker 1: Poop is a valuable resource a fertilizer, as a source
Speaker 1: of public health data like wastewater can tell us what pathogens.
Speaker 3: Are currently circulating.
Speaker 1: Huge, huge, And it's also a valuable resource on an
Speaker 1: individual level, Like what does your pooh say about you?
Speaker 2: Such a good question.
Speaker 3: Well, Aaron, this is where I pose that question to you,
Speaker 3: so you can tell me all about what we can
Speaker 3: learn from our poop.
Speaker 2: I cannot wait to do that. So I ended last
Speaker 2: week's episode mostly just talking about what is typical when
Speaker 2: it comes to our poops, right, yeah, yeah, And you
Speaker 2: talked to us through in last week's episode, if anyone
Speaker 2: missed it, all of the different ways that animals use
Speaker 2: our poop as a resource, and poop on a landscape
Speaker 2: level scale tells us so much about how we're dealing
Speaker 2: with Our poop can tell us a lot. But you're right,
Speaker 2: on an individual level, our poop can also tell us
Speaker 2: quite a lot. And I think there's an interesting balance,
Speaker 2: I guess where a lot of us don't think about
Speaker 2: our poop at all. Like we poop and it's done,
Speaker 2: it is out of our mind. We're not worried about it,
Speaker 2: we're not looking at it, we're not thinking about it.
Speaker 2: We're just maybe trying to think about it as little
Speaker 2: as possible. And there are also many people who maybe
Speaker 2: spend a little too much time thinking about their poops
Speaker 2: or worrying about their poops or what is this one poop?
Speaker 2: Did I eat beats? Or is this cooling cancer?
Speaker 3: I mean, that's a reasonable question to ask.
Speaker 1: After a beat, after a beat, poop after a beat, poop,
Speaker 1: unless it's beats.
Speaker 2: But it is true that our poops can tell us
Speaker 2: so much about our health, and a lot of times
Speaker 2: changes in our bowel movements might actually be indicator of
Speaker 2: an underlying disease. Though my point with today is not
Speaker 2: necessarily to make everyone worried about their poops. It's more
Speaker 2: just to kind of understand the spectrum. Okay, And since
Speaker 2: we already covered the range of typical, we can look
Speaker 2: back at our Bristol stool scale to understand the ways
Speaker 2: in which our poop can become a typical. If that
Speaker 2: makes sense. Love this. So if a perfect poop on
Speaker 2: that Bristol scale, which again goes from one to seven,
Speaker 2: where one are these hard, separate lumps kind of like
Speaker 2: a nut of poop, chunk chunk, PLoP, PLoP, and types.
Speaker 3: Are appreciate that extra little little.
Speaker 2: Too much, and a type seven is entirely liquid. Those
Speaker 2: are our two extremes constipation and diarrhea. Yes, and so
Speaker 2: that's what I'm going to kind.
Speaker 3: Of focus on constipation and diarrhea.
Speaker 2: Constipation and diarrheall so, and there's a lot of different
Speaker 2: ways to classify. Those are not the only poop problems
Speaker 2: that you can have, but constipation and diarrhea I think
Speaker 2: give us a lot of insight because that does kind
Speaker 2: of cover that whole spectrum.
Speaker 3: Right.
Speaker 2: So there's a lot of different ways to classify or
Speaker 2: define both of these things. And I'll start with constipation
Speaker 2: because I love talking about constipation.
Speaker 3: So has that word been uttered in the history.
Speaker 2: I'll see it in the office all the time, So
Speaker 2: I love talking about constipation. How we actually define it,
Speaker 2: it's either with this bristol stool scale, but it's never
Speaker 2: just exclusively with the bristol stool, So it's usually hard
Speaker 2: or lumpy stools, or needing to strain during a bowel movement,
Speaker 2: or sometimes feeling like I just can't completely evacuate, like
Speaker 2: you poop and you just feel like there's something still
Speaker 2: there that needs to come out but it cannot come
Speaker 2: out feeling. If those things are happening, usually more than
Speaker 2: twenty five percent of your poops, that's what's considered.
Speaker 3: Constipated, huh okay.
Speaker 2: Or sometimes it can be if you're having fewer than
Speaker 2: three bowl movements per week, that might also be considered
Speaker 2: you constipated.
Speaker 3: Okay, how often? Like okay?
Speaker 2: I love that you're asking questions already.
Speaker 3: I know, I know, well you said fewer that you
Speaker 3: said more than or twenty five.
Speaker 2: Twenty five percent of your poops, So who's watching that.
Speaker 2: That's such a great question, who, like, how many of
Speaker 2: us are paying that much attention to our poop? Right,
Speaker 2: I don't know unless maybe you're dealing with constipation, and
Speaker 2: then you probably are, because a lot of times it's
Speaker 2: maybe more than twenty five percent, Right, it has to
Speaker 2: be at least that for us to call it constipation
Speaker 2: according to the like Rome criteria, which is the criteria
Speaker 2: that we use. But a lot of people who deal
Speaker 2: with constipation have been dealing with it for a really
Speaker 2: long time. It's estimated most of the studies cite that
Speaker 2: in the US something like twelve to fifteen percent are
Speaker 2: dealing with constipation, and a lot of times, unless we
Speaker 2: can identify the cause of constipation, it gets lumped under
Speaker 2: what's called like functional constipation, which really just means that
Speaker 2: we don't necessarily have an idea of what the mechanisms are.
Speaker 2: But it's estimated that up to thirty percent of people
Speaker 2: deal with constipation at least on an occasional basis, so
Speaker 2: they like sometimes have issues pooping, and that is thought
Speaker 2: to be an underestimate because these are data that are
Speaker 2: based on people who seek care. Right of course, right.
Speaker 1: Are you going to talk about the causes of constipation,
Speaker 1: because I want to talk about functional constant.
Speaker 3: Like to me, what's your question, what are the causes
Speaker 3: of constipation?
Speaker 2: That great questions?
Speaker 1: At what point do you go? We don't know, but
Speaker 1: you're clearly constipated.
Speaker 2: Yeah, I mean, it totally depends on the scenario and
Speaker 2: also depends on how well it responds to the various
Speaker 2: treatment options. Right, But there's a lot of things that
Speaker 2: could cause it. It could be that you have slow
Speaker 2: gut transit, right, which we know from last episode, can
Speaker 2: be caused by a number of different things. Some of
Speaker 2: it might be genetics, some of it might be medications
Speaker 2: that you're on. Some of it might be the diet
Speaker 2: that you are eating, is that right, The diet that
Speaker 2: you're eating, diet, the food that your diet or diet.
Speaker 2: Some of it might be diet because fiber, as we know,
Speaker 2: can increase your stool transit time, and so if your
Speaker 2: diet is very low in fiber, then you might have
Speaker 2: prolonged transit times, so you might be more prone to constipation. Also,
Speaker 2: dehydration can put you at risk of harder stools. Physical
Speaker 2: activity increases your motility of your guts, and so we
Speaker 2: all live much more sedentary lifestyles, especially like in the
Speaker 2: US we're quite sedentary, and so that is actually probably
Speaker 2: contributing to constipation. But then there's other things too. There's
Speaker 2: like just actual dysmotility. There's something called Hirsprungs, which is
Speaker 2: like where it's a genetic disorder where some of your
Speaker 2: nerve endings of your colon have not developed all of
Speaker 2: the way and so you cannot get contraction the way
Speaker 2: that you should. So that can make it very hard
Speaker 2: to poop and you can get a huge amount of
Speaker 2: stool build up in things. There's pelvic floor dysfunction, anal
Speaker 2: sphincter issues, like there's a lot of possibilities, A lot.
Speaker 1: Of possibilities, Are there a lot of solutions?
Speaker 2: Is that great question? I mean yes and no. Right,
Speaker 2: the main ways that we go and deal with constipation,
Speaker 2: for like a general rule, are going to be using
Speaker 2: things like laxatives, which are going to hold on to
Speaker 2: water in your stool, so that is going to make
Speaker 2: your stool softer.
Speaker 3: That how they work.
Speaker 2: That's how they work. They just still like okay, mirralax,
Speaker 2: which is polyethylene glycol. There's lots of different brand names
Speaker 2: of it. It's just a very large molecule, and so
Speaker 2: it just attracts water. And so you have this molecule,
Speaker 2: it doesn't get broken down in your digestive tract. So
Speaker 2: it's sitting in your colon holding on to water, and
Speaker 2: therefore you have more water in your poop. Therefore it
Speaker 2: is softer and easier to pass. And other osmotic laxatives
Speaker 2: work the same way. Lactolose, magnesium citrate, all these things.
Speaker 2: There's also some other ones that you can use, like
Speaker 2: stimulant laxatives. Those are things like bisocotal is one or
Speaker 2: senna is another, and these are helping to stimulate paristolsis.
Speaker 2: They're helping to stimulate muscular contractions.
Speaker 1: So it's not like a laxative the water aspect, but
Speaker 1: in the movement it's moving.
Speaker 2: Yeah, it's helping with movement, and so what you might
Speaker 2: use might depend on what you think the underlying issue is,
Speaker 2: so it's going to be kind of person dependent. There's
Speaker 2: also stool softeners. But my favorite thing about stool softeners
Speaker 2: in medicine is that we use them all the time
Speaker 2: and there's like no data that they work. Wait, what, doc,
Speaker 2: you say? It is like one of the most commonly
Speaker 2: used things in hospitals, and like people like to tell
Speaker 2: people to use it all the time, and there's like
Speaker 2: very little if any evidence that it. It's supposed to
Speaker 2: just like help make your stool more slippery, is the idea,
Speaker 2: like mucisi me, I don't know, but it doesn't like
Speaker 2: it doesn't work, okay.
Speaker 1: So so when you say it doesn't work, do you
Speaker 1: mean that there have been studies that have found no effect.
Speaker 3: Yeah, there have been no studies.
Speaker 2: There have been studies that have had no effect. Yeah,
Speaker 2: unlike othmotic laxatives and things which great.
Speaker 3: So why why would you use the stool softener over
Speaker 3: a laxative.
Speaker 2: I don't know. I don't, okay, okay, but lots of
Speaker 2: people do. I don't know. It's thought to be less harsh, okay, right,
Speaker 2: because it's not gonna like grab onto a bunch of
Speaker 2: water and then like have you at risk of diarrhea
Speaker 2: or something quite as much? Right, where you can easily
Speaker 2: overdo it with some laxative. So you could end up
Speaker 2: with electrolyte imbalances if you overdo it on laxatives things
Speaker 2: like that. But realistically I don't know because I don't But.
Speaker 3: What about the like prep for a colonoscope.
Speaker 2: It's basically a huge jug of polyethylene gicoll or. Sometimes
Speaker 2: we use sodium based ones too, so like other electron electrode. Yeah, yeah, yeah, okay,
Speaker 2: but yeah, that's basically what it is, Just like a
Speaker 2: huge jug of it, chug chug, chug with a lot
Speaker 2: of water because you're going to be pooping out a
Speaker 2: lot of water.
Speaker 3: I know.
Speaker 2: Isn't that fun?
Speaker 3: Yeah, it's great. Fun. Yeah, fun, that's exactly the word
Speaker 3: that I would use. Yeah.
Speaker 2: But so that's like, I mean, that's that's most of
Speaker 2: the ways that we try. And there's other newer medicines too,
Speaker 2: Like there's a lot of there's a lot of newer
Speaker 2: medicines that have mechanisms that I'm not going to get
Speaker 2: into because I'm not as familiar with it, but there's
Speaker 2: a lot of Because constipation is such an issue, there
Speaker 2: are a lot of interest in new ways to help
Speaker 2: deal with constipation. When these are not effective, these is
Speaker 2: like go to first line try it out. If it's
Speaker 2: not working, you need to see a specialist kind of
Speaker 2: a thing.
Speaker 1: Okay, question about constipation and treatments the like uh, polyethylene
Speaker 1: gli call et ceteras of the world. Are those for
Speaker 1: acute relief or in is the more like chronic relief?
Speaker 3: Fiber?
Speaker 2: Yes, it's yes, And okay, do you want to talk
Speaker 2: about fiber? I can skip.
Speaker 3: We can know. We keep your notes the way you
Speaker 3: want them to keep.
Speaker 2: Let's talk about fiber.
Speaker 3: Great. Always I'm always down to talk about fiber.
Speaker 2: I know me too, Okay, So yes, laxatives, stool softeners,
Speaker 2: motility agents. These are things that are going to help
Speaker 2: treat constipation. Yes, what if you are constipated? Fiber does
Speaker 2: not necessarily treat constipation, but it can help prevent constipation, right, Okay,
Speaker 2: because like we talked about last episode, it's holding onto
Speaker 2: water in your stool, and so it is hugely beneficial
Speaker 2: in increasing transit time and in making your stool softer,
Speaker 2: and in providing that bulking agent. And there's two major
Speaker 2: divisions of fiber. There's soluble fibers, which is like cilium, husk, oats, pectins,
Speaker 2: and then there's insoluble fibers, which is like wheat brand cellulose.
Speaker 2: Lots of the things that are in our fruits and
Speaker 2: veggies and things.
Speaker 1: I can't believe we're getting to talk about insoluble and
Speaker 1: soluble fibers.
Speaker 3: So excited.
Speaker 2: Yeah, And most of the if you're getting your fiber
Speaker 2: from food sources and not from like a fiber drink
Speaker 2: that you're mixing, then you're getting a combination of soluble
Speaker 2: and insoluble fibers in most of the foods that you're eating.
Speaker 2: And then there's also some of the fibers are like fermentable,
Speaker 2: and I talked a little bit about this last episode,
Speaker 2: Like the bacteria in our guts can break them down
Speaker 2: and ferment them specifically to produce these like short chain
Speaker 2: fatty acids that they can then.
Speaker 3: Use to eat.
Speaker 2: Like the bacteria eat break down this fermentable fiber and
Speaker 2: eat it, and then some of the cells in our
Speaker 2: colon can also use what they break down as an
Speaker 2: energy source, these short chain fatty asss.
Speaker 1: Okay, why choose one fiber over the other, and why
Speaker 1: are they all important?
Speaker 3: They're all important?
Speaker 2: The answer is that they're all important. Some of them
Speaker 2: are increasing bulk in our stool, and some of them
Speaker 2: are helping to feed the gut microbiome, and all of
Speaker 2: them are kind of doing both, like really, if we
Speaker 2: get into it, and so that that is why fiber.
Speaker 2: That's why people get so like stoked about fiber and
Speaker 2: why fiber is such an important part. There's also so
Speaker 2: much interesting data on like fiber because of its effects
Speaker 2: on our gut microbiome in helping to treat or at
Speaker 2: least prevent the worsening of a lot of like inflammatory diseases.
Speaker 2: Colon cancer we think is involved, like our low fiber
Speaker 2: diets we think are maybe involved in the increasing incidents
Speaker 2: of colon cancer that we see, especially in early onset
Speaker 2: colon cancer. It's not one thing, it's many things, but
Speaker 2: fiber is a part of that story. So it's it's huge.
Speaker 2: And part of the reason that this is important to
Speaker 2: you is because constipation, while it's an issue in and
Speaker 2: of itself, it can be very painful. It can, like constipation,
Speaker 2: can cause its own set of problems, constipation can also
Speaker 2: cause other problems. Constipation can put you at risk of
Speaker 2: things like diverticulosis, which are these little out pouchings of
Speaker 2: your gut wall, especially in the stigmoid colon the part
Speaker 2: that sneaks around back before the rectum, and those little
Speaker 2: out pouchings can trap poop and then can get infected
Speaker 2: or can burst or can burst into a blood vessel
Speaker 2: and cause a lot of bleeding. So diverticulosis can be
Speaker 2: a problem, and constipation is a big contributor to diverticulosis
Speaker 2: is not the only thing, but it's one. Also hemorrhoids
Speaker 2: m okay, hemorrhoids are basically everyone actually has hemorrhoids.
Speaker 1: Can I before we go onto hemorrhoids, because I do
Speaker 1: want to talk about hemorrhoids, but I want to I
Speaker 1: want to go back.
Speaker 3: To fiber unless we're done.
Speaker 2: Are you end of fibert Yeah?
Speaker 1: Tell me a good question the relationship between fiber. I'm
Speaker 1: just stuck on these different insoluble soluble. It's fermentable.
Speaker 2: Don't ask me more details, you know, But like.
Speaker 1: We when we talk about a low fiber diet, it
Speaker 1: is of course across the board. But are we getting
Speaker 1: like is the low fiber diet more low in soluble insoluble?
Speaker 1: And are the relationships between these different fiber types and
Speaker 1: colon cancer for instance, or like other outcomes.
Speaker 2: It's a good question. It's beyond I don't know.
Speaker 1: Okay, And then how much? So no one's getting enough fiber?
Speaker 1: How much is enough fiber? What does that look like?
Speaker 1: Our fiber. Uh do do our fiber?
Speaker 3: What do you call them?
Speaker 2: Fiber, fiber, cereals, fiber bars, fiber supplement.
Speaker 3: Fiber powders.
Speaker 2: Ye, yeah, yeah, I love these questions. The recommended amount
Speaker 2: in the US is like twenty eight to thirty five
Speaker 2: grams of fiber a day. Okay, okay, a cup of
Speaker 2: raspberries as an example. I can't believe I know this
Speaker 2: in my head because I didn't write anything.
Speaker 3: We've talked about this, because raspberries especially are very high fibers.
Speaker 2: Of all the fruits, they're one of the best. Because
Speaker 2: a cup of raspberries is like eight grams or so
Speaker 2: of fiber a cup, so it's like pretty dece Kiwis
Speaker 2: also have a lot of fiber. Broccoli has a ton
Speaker 2: of fiber. Beans, especially white beans, so much fiber means
Speaker 2: white interesting, navy beans have more fiber than most other beans.
Speaker 2: Don't ask me why, No clue. Oh, lentils, lentils, lots
Speaker 2: of fiber. Don't know how much. I don't have the
Speaker 2: rest of them memorized because I usually just give people
Speaker 2: a chart. It's one of my that's my standard handout.
Speaker 2: If you come see me for a physical that's literally
Speaker 2: part of my hand.
Speaker 3: Bring bring one next time, yea time we're together.
Speaker 2: Okay, I just got it from the like NIH website
Speaker 2: or whatever. Okay, yeah, still I didn't make it. But no,
Speaker 2: so that that's a recommended amount, and most of us
Speaker 2: are probably getting much less than that. Like if you
Speaker 2: but your question about like fiber supplements and things like
Speaker 2: that can be really helpful, especially some of those soluble
Speaker 2: fibers like sillium husk and things like that tend to
Speaker 2: tolerate really well because they're not going to be as fermentable.
Speaker 2: You're going to get a little bit less bloating potentially
Speaker 2: with those, but you could you could get bloating with anything,
Speaker 2: especially if you're going from like no fiber right to
Speaker 2: some fibert start small, baby steps, baby steps. Always, this
Speaker 2: is not a medical advice podcast. Let me remind you all,
Speaker 2: we're just talking generalities. But yeah, so that's that I
Speaker 2: answer all those questions. Those count. But of course it
Speaker 2: is better if you're getting your fiber from whole foods
Speaker 2: because then you are getting a mix. And I don't
Speaker 2: know the answer as to like what percentage should be
Speaker 2: this or that, and like there's probably people who are
Speaker 2: doing those studies to kind of really look into it.
Speaker 2: But I don't know the answer to that.
Speaker 1: I know, and this like we haven't said this yet,
Speaker 1: which I'm shocked that we haven't said this. But there
Speaker 1: are so many other topics that are related to poop, yes,
Speaker 1: that we will cover.
Speaker 2: There's so many that I'm like, I will say this
Speaker 2: word and then we need to do a whole episode
Speaker 2: on it.
Speaker 3: Colon cancer, cool and cancer, early on set, colon cancer,
Speaker 3: so many things huge, Yeah, diverticulosis.
Speaker 2: Speaking of hemorrhoids.
Speaker 3: Hemorrhoids, so this could be a whole episode.
Speaker 2: Oh my god, it actually would be.
Speaker 1: I want to know about the because I was thinking
Speaker 1: about the development of laxatives.
Speaker 2: Oh interesting, right, okay, so we.
Speaker 1: Should do a and also the development of something hemorrhoid
Speaker 1: cream and whether it is true that you should put
Speaker 1: them under put it under your eye for puffiness. I
Speaker 1: feel like that was something in miscongeniality.
Speaker 3: Really, that's where I learned that.
Speaker 2: I mean, it's just like a low poncy steroid usually. Anyways,
Speaker 2: we're getting off the point Listen, hemorrhois hemorrhoids. Everyone has hemorrhoids.
Speaker 2: They're just collections of blood vessels that are in your
Speaker 2: rectum and your anus, so they function like cushions basically
Speaker 2: that help keep your anal canal closed because we want
Speaker 2: it closed most of the time. They help soften the
Speaker 2: transitive poop, so your poop has like do do think
Speaker 2: of it as like bointing off.
Speaker 3: Like a little pinball machine, like a pinball gently off.
Speaker 2: But they also they are basically collections of blood vessels.
Speaker 2: And because they are venous vessels, like they're veins, not arteries.
Speaker 2: Our veins can get swollen, and as they get swollen,
Speaker 2: they can sometimes burst open and bleed, either in small
Speaker 2: amounts or sometimes in larger amounts, and depending on where
Speaker 2: they form in the anal canal. Your anal canal is
Speaker 2: so interesting because some of it has sensory sensation. The
Speaker 2: external part you can feel it has a lot of
Speaker 2: nerve endings, and the inner part does not. So if
Speaker 2: you have internal hemorrhoids, they generally don't have any pain
Speaker 2: or discomfort or itching, but external hemorrhoids can cause quite
Speaker 2: a lot of itching and pain because especially they don't
Speaker 2: tend to burst open, though they can, but they can
Speaker 2: get very large and very very painful because they're like
Speaker 2: external so you're basically like sitting on them. So those
Speaker 2: can be quite painful, like little water balloons filled with
Speaker 2: blood basically right around your opening. And so those are
Speaker 2: you are at higher risk for those with constipation, like big, big,
Speaker 2: big time, because it is all of that increased pressure
Speaker 2: and the straining straining to poop really puts a lot
Speaker 2: of pressure on that anal canal, and so it really
Speaker 2: increases the pressure in those veins, so then blood pools
Speaker 2: up in there.
Speaker 1: I'm just I'm thinking of as someone who listens to
Speaker 1: a lot of like books on tape and in my
Speaker 1: car and when I'm running and walking the dog and
Speaker 1: when someone gets in the car with me and I
Speaker 1: have like, you know, like a colorful scene in one
Speaker 1: of five books I'm imagining of all of our episodes.
Speaker 2: Someone is playing this and.
Speaker 1: They're they're like, I don't know, brother in law gets
Speaker 1: in the car. It's like, I'm you know what exactly
Speaker 1: they have on the bluetobe speaker.
Speaker 2: Yeah, yeah, this is one to share with your family.
Speaker 2: Please do, because I'll keep going to tell you about
Speaker 2: anal fissures, which are another consequence of constipation.
Speaker 3: Consequence of constipation not related to hemrhoids.
Speaker 2: Not directly related except that they're both like an anal
Speaker 2: disease basically, But anal fissures are also this increased pressure
Speaker 2: sitting constipation issue. They're just teeny tiny, little like paper
Speaker 2: cuts almost in the skin of the anus, and so
Speaker 2: they're super super painful. So treatment for that is really
Speaker 2: to avoid constipation, and sometimes you need surgeries and things
Speaker 2: like that to kind of help treat those. So yeah,
Speaker 2: So constipation is a big deal, right because it can
Speaker 2: be a problem in and of itself, and it can
Speaker 2: cause all of these other problems. There's something called stircurle colitis.
Speaker 2: We won't even get there because it's quite extreme. But
Speaker 2: on the other arm, now I'm like, what, I don't
Speaker 2: google it after that. On the other end of the
Speaker 2: spectrum is diarrhea. Yes, and we've talked a lot about diarrhea.
Speaker 2: I spent more time on constipation because we don't ever
Speaker 2: really cover it on the podcast, but we've talked quite
Speaker 2: a lot about diarrhea. You define acute diarrhea as like
Speaker 2: three loose or watery stools in twenty four them. My
Speaker 2: kid will tell you I only had two, so it's
Speaker 2: not diarrhea. They're well trained. But chronic diarrhea we define
Speaker 2: as loose or watery stools similar to constipation in at
Speaker 2: least twenty five percent of your stools, lasting for at
Speaker 2: least three weeks. Okay, that would call chronic diarrhea.
Speaker 3: Yeah.
Speaker 2: And one of the biggest issues with diarrhea is that
Speaker 2: you're getting a lot of water loss with it, right,
Speaker 2: and diarrheal poops tend to be not only higher in
Speaker 2: water content, they also tend to be higher in protein content.
Speaker 2: And as you're losing all this water, you're also losing
Speaker 2: all those electrolytes that are with that water. So with diarrhea,
Speaker 2: you're at really high risk of dehydration and electrolyte imbalance. Uh.
Speaker 3: Protein, Yeah, because.
Speaker 2: Things are just not getting digested and broken down all
Speaker 2: the way. So fats too. Depending on the type of diarrhea,
Speaker 2: it could be. It just depends on It depends on
Speaker 2: what your GI tract is able to absorb versus not.
Speaker 3: What do you mean by t types of diarrhea.
Speaker 2: I mean what is causing your diarrhea can affect the
Speaker 2: type of diarrhea that you are having. So for example,
Speaker 2: if you have an infection that's just tearing through your
Speaker 2: gi tract so that your say, colon just isn't really
Speaker 2: absorbing any water. Then you're just going to have really
Speaker 2: watery stools. But you're still going to probably be absorbing
Speaker 2: all those nutrients because that happens in your small intestine. Yes, Okay.
Speaker 2: On the other hand, if you have no more gallbladder,
Speaker 2: then you are leaking out by all all the time. Yeah,
Speaker 2: So you might have less ability to digest fats, so
Speaker 2: you have more fat that just made it all the
Speaker 2: way through to your colon and that is providing a
Speaker 2: slippery slide. Then you might have diarrhea that is more
Speaker 2: fatty and is floaty fatty. But there's just I mean,
Speaker 2: there's lots of ranges of diarrhea, and like you were
Speaker 2: talking about, there's lots of ranges of smells of diarrhea.
Speaker 2: There's some people who are like, I can smell a
Speaker 2: sea dip diarrhea versus not. So is it infectious, is
Speaker 2: it chronic diarrhea? Is it more of an acute diarrhea?
Speaker 2: All of them, though, can put you at risk of
Speaker 2: things like collectrolide imbalance and dehydration and all.
Speaker 3: Of that chronic diarrhea. Okay, Yeah, yeah.
Speaker 2: And prevalence rates when it comes to diarrhea, I don't
Speaker 2: have like a one statistic like we do for constipation
Speaker 2: because they range hugely. And we've talked so much on
Speaker 2: this podcast about acute infectious diarrhea, especially in low and
Speaker 2: middle income countries. How many kids die from diarrhea every
Speaker 2: year is in the millions. It's very depressing. But even
Speaker 2: in high income countries, it's estimated that chronic diarrhea, the
Speaker 2: prevalence can range from like three to eight percent, which
Speaker 2: is not a small amount of people. No. So there's
Speaker 2: a lot of different things that can cause both constipation
Speaker 2: and diarrhea, but one that I want to kind of
Speaker 2: talk about because it can actually cause both. Okay is IBS.
Speaker 3: Yeah, okay, okay, okay.
Speaker 2: Yeah, And again this probably deserves its whole lon always
Speaker 2: does we need to do one, Yeah, we do.
Speaker 3: Don't please don't take this as we're just going to
Speaker 3: throw this in.
Speaker 2: No, no, But but I can't do a whole two
Speaker 2: episodes about poop and not talk about IBS, especially about
Speaker 2: problematic poops, because talk about the poster child of problematic pooping.
Speaker 2: Yes it's IBS, So IBS or irritable bowel syndrome, not
Speaker 2: the same thing, by the way, as IBD, or inflammatory
Speaker 2: bowel disease, which very commonly causes diarrhea, especially bloody diarrhea,
Speaker 2: and is an autoimmune disease, an inflammatory and a huge problem.
Speaker 2: IBS is not that it used to be like a
Speaker 2: diagnosis of exclusion, but it's not anymore interesting now. It's
Speaker 2: very much like you should positively diagnose this as IBS.
Speaker 2: What is the criteria, Well, they can they can range
Speaker 2: a little bit, but the core core criteria are recurrent
Speaker 2: cramping abdominal pain. Okay, So you get cramped, being pain,
Speaker 2: and then changes in stool frequency or consistency, and this
Speaker 2: is where it can range. Some people have what's called
Speaker 2: IBS C, which is IBS with constipation, some people have
Speaker 2: IBS D, which is IBS with diarrhea, and some people
Speaker 2: have mixed CD CDM. We call it though, oh, mixed,
Speaker 2: because you have both either constipation or diarrhea, but you're
Speaker 2: having these changes in your stool frequency like I'm having
Speaker 2: a poop all the time all of a sudden, or
Speaker 2: consistency where like i was having like a Bristol three
Speaker 2: or four and now I'm a seven.
Speaker 3: Okay, I'm just so confused about changes in yeah, because
Speaker 3: that implies a time period.
Speaker 2: This has to be for at least three months, and
Speaker 2: it has to be happening at least three I think
Speaker 2: three times a week is the three times a week
Speaker 2: this is the criteria. The d or C is the
Speaker 2: the changes in your stool. Yeah, so, like what is
Speaker 2: your and it's associated with this cramping. So you're having
Speaker 2: this pain and then you have either a constipated poop
Speaker 2: or a diarrheal poop or one or the other.
Speaker 3: And it's happening for three months months Yeah, yeah, Okay.
Speaker 2: And we still do not understand IBS. It's the reserving
Speaker 2: of its whole own episode. But we are pretty sure
Speaker 2: that it is at least in part a disorder of
Speaker 2: the gut brain axis, which is just so interesting and fascinating.
Speaker 1: To me, I know, I mean, the phrase itself is
Speaker 1: is really compelling.
Speaker 3: And what's underneath the surface we don't know. Question.
Speaker 2: But yeah, So it's basically like your guts and your
Speaker 2: brain are not talking to each other the way that
Speaker 2: they should.
Speaker 3: Ye.
Speaker 2: Your neurotransmitters are probably involved. Serotonin. You have more of
Speaker 2: it in your gut than you do in your brain,
Speaker 2: et cetera. But then you also see with this intestinal dismotility.
Speaker 2: So whether that is your guts are going too fast
Speaker 2: and so you're just pooping your brains out because you're
Speaker 2: not absorbing things because they're moving too quickly or you're
Speaker 2: going really slow and there that's why you're constipated. A
Speaker 2: And this is really interesting, visceral hypersensitivity, and that's where
Speaker 2: you get this pain. So viscera is like your your
Speaker 2: guts and hypersensitive, meaning that your nerve endings are feeling
Speaker 2: more pain than they should.
Speaker 3: Interesting.
Speaker 1: So because we've talked about hypersensitivity before when I.
Speaker 2: Don't remember the metriosis maybe maybe, yeah, yeah, And.
Speaker 3: So it's the same sort of thing. It's like those
Speaker 3: pathways have been carved out and so like it's like
Speaker 3: a super.
Speaker 2: Highway yes to pain, Yeah, exactly exactly. But so yeah,
Speaker 2: So there's a lot there's a lot of research being
Speaker 2: done in IBS. There are a lot of new medications,
Speaker 2: especially to treat like IBS with constipation. There's medicines that
Speaker 2: are specific for that same thing with IBS with diarrhea.
Speaker 2: So like there's a lot of research, but there's also
Speaker 2: a lot of people who just like suffer with either
Speaker 2: constipation or diarrhea, and they're looking for ways to manage it,
Speaker 2: and so they turn to things like fiber or prebiotics,
Speaker 2: which are all the rage right now, which is usually
Speaker 2: just fiber. Really, Yeah, they just market it in a
Speaker 2: weird and different way. Prebiotics that's what they're okay, and
Speaker 2: then probiotics is the other one. Ah, So let's talk
Speaker 2: a little bit more about probiotics, because again, we can't
Speaker 2: talk about poop and not talk about probiotics. It's not
Speaker 2: I think the last time we talked about probiotics was
Speaker 2: in our c Diiff episode. Yep, sure, I don't remember
Speaker 2: I honestly though, that was a long time ago, that episode,
Speaker 2: and I'm not sure that we have that much more
Speaker 2: data than we did way back then. People use probiotics,
Speaker 2: and they will recommend that you take probiotics for anything
Speaker 2: from diarrhea to constipation to bloating, whether that's acute infectious
Speaker 2: diarrhea or chronic diarrhea. Right, there's very little data that
Speaker 2: show that there is a benefit to probiotics depending on
Speaker 2: the certain circumstance that you're using them for.
Speaker 3: Tell me about those circumstances.
Speaker 2: Well, most of the data. Most of the data is
Speaker 2: on antibiotics asociated diarrhea or like if you use antibiotics
Speaker 2: or you're using antibotics for something like c DIFF. And
Speaker 2: even then the data is really really mixed. The biggest
Speaker 2: issue is that there's huge heterogeneity in how each of
Speaker 2: these studies are conducted.
Speaker 3: And who's conducting them.
Speaker 2: Who's conducting that Mostly it's like people who are making
Speaker 2: supplements or yogurt or something, So there's that issue, But
Speaker 2: there's also just huge heterogeneity and like which bacterial strains
Speaker 2: are they actually using in this study? How many bacteria
Speaker 2: are you actually getting in that capsule?
Speaker 3: Well, because it's got to go through your stomach.
Speaker 2: Exactly, it has to survive the acidic environment of your stomach,
Speaker 2: it has to make it through your small intestine to
Speaker 2: try and colonize your colon. We know now that that's
Speaker 2: like a twenty plus foot journey, so that's not necessarily easy.
Speaker 2: There's also a huge issue with the fact that in
Speaker 2: the US there's absolutely no regulation on these things because
Speaker 2: probiotics are regulated as supplement and see our supplement.
Speaker 3: Episode for so much more.
Speaker 2: Yeah, we or they're sometimes classified as a food product,
Speaker 2: right if it's like a yogurt or yogurt drink or
Speaker 2: something like that. So we don't have really any data
Speaker 2: on how much live bacteria are even in your gummy
Speaker 2: or your capsule or your juice drink, how much of
Speaker 2: those will survive, or if that particular strain is necessarily
Speaker 2: beneficial for you in your specific clinical scenario.
Speaker 1: I know, I honestly it is. Really it's really frustrating.
Speaker 1: Like the I think in particular, one of my one
Speaker 1: of my irritants is the probiotic soda. Yes, and I'm
Speaker 1: just like it's soda, it's sugar, yeah, what, it's just
Speaker 1: I mean, I'm sure there's more stuff in there, but like.
Speaker 2: Right, some of them are have prebiotics, so again they've
Speaker 2: got like fiber or like non digestible sugar.
Speaker 3: Okay.
Speaker 2: Great. The other issue too, is that we have some
Speaker 2: data on a few species. We've got some decent data
Speaker 2: on Biffitobacterium that at least it's probably not harmful. On
Speaker 2: a few species of Lactobacillus that again, they are good
Speaker 2: colonizers and they're not harmful. And sacrimices, which is actually
Speaker 2: a yeast, right, but that's just like three and like
Speaker 2: a couple species of Lactobacillus. Right, So if we're talking
Speaker 2: a handful of species out of the thousands that colonize
Speaker 2: our guts, like, we don't know what we're doing when
Speaker 2: it comes to probiotics, we don't. So there are people
Speaker 2: who say, well, taking one or two species is never
Speaker 2: going to be enough. It's never going to do the
Speaker 2: thing that you needed to do. What we need is
Speaker 2: a fecal transplant erin.
Speaker 1: Okay, before we talk about fecal transplants, Yeah, I do.
Speaker 1: I feel like every time we end up talking about
Speaker 1: the microbiome, we did it.
Speaker 3: More recently aerin and I don't remember what it was.
Speaker 3: We're always like, the hype is overrated, and it's the
Speaker 3: hype is not overrated for the microbiome it itself, No,
Speaker 3: it is for our understanding of it correct and how
Speaker 3: we are able to manage and optimize it because we
Speaker 3: just aren't there yet, right, maybe we will be, but
Speaker 3: we're not there.
Speaker 2: No, not even closed. And I are are we there
Speaker 2: with fanfre we no or not? But fecal transplants are
Speaker 2: essentially like that. That is one of the answers. Right,
Speaker 2: It's like, well, okay, giving someone just some lacto bacillis
Speaker 2: or lactobacillis and biffittobacteria like two little bacteria. Is that
Speaker 2: going to change the entire architecture of their gut microbiome?
Speaker 2: Probably not right, but hitting them with someone else's entire
Speaker 2: gut microbiome might. And that's the idea behind fecal microbiota
Speaker 2: transplant or FMT. This is a huge field of research.
Speaker 2: I will not do it justice, however. The idea is
Speaker 2: basically that you take a microbial community from a healthy
Speaker 2: person's guts, someone with bristol three or fours all the time.
Speaker 3: Beautiful poop, no blowing east exceptional.
Speaker 2: Love it all the time, and you give it to
Speaker 2: a person with some kind of gut disease. You give
Speaker 2: them some of their poop because in that poop, again,
Speaker 2: fifty percent of the biomass of their poop is bacteria.
Speaker 2: You can do this a few different ways. You can
Speaker 2: instill the poop into somebody via colonoscopy from the bottom
Speaker 2: or an NG tube from the top, because you wouldn't
Speaker 2: want to just eat it because that's gross. But you
Speaker 2: could make it into pellets, and then you could take
Speaker 2: it as a capsule. You can freeze dry them, or
Speaker 2: you can freeze them either way, And there is so
Speaker 2: much research being done on this. It is used clinically already,
Speaker 2: but only in one scenario so far outside of the
Speaker 2: research sphere as of recording. So there is a FDA
Speaker 2: approved treatment here in the US for recurrent se diff
Speaker 2: infection that is an FMT. There's two approved products. One
Speaker 2: of them is given via an enema suspension and the
Speaker 2: other one is oral capsules, which is just really exciting
Speaker 2: because that's so much more palatable to people. Yeah, then
Speaker 2: and also like lower barrier to edge because you don't
Speaker 2: have to go into the office, you don't have to
Speaker 2: do it in clinic, et cetera. You could justo is
Speaker 2: that you just pop it in your mouth, it wallow
Speaker 2: it down. So it's a very exciting area of research.
Speaker 2: But that's all that I really have about it. Because
Speaker 2: there's a lot of people who are wanting to use
Speaker 2: it for a treatment of IBD. There's some really promising
Speaker 2: research in that area. There's some promising research on it
Speaker 2: for IBS even which I think is very exciting. But
Speaker 2: that's all that I really have about that.
Speaker 1: I mean, we could do a whole another whole I
Speaker 1: know that in our CDF episode we did like a
Speaker 1: big segment on.
Speaker 2: We did FMTS shout out to doctor imaj Di Ausmann,
Speaker 2: who we had on the pod.
Speaker 1: Great, But I think that we could do a whole
Speaker 1: like update episode on it because I also want to know, like, Okay,
Speaker 1: people who got a fecal transplant.
Speaker 3: Five years ago, how are they doing now? What are
Speaker 3: their poop like today?
Speaker 1: Do they have the same microbes that they were you know,
Speaker 1: laced with in that first certainly not.
Speaker 2: I would think that there's some turnover.
Speaker 3: So there's turnover, But I mean, like, how much does
Speaker 3: the community community?
Speaker 2: Oh, it's so interesting erin. I know, there's just so
Speaker 2: much I think about our guts and our poop that
Speaker 2: is exciting, I know.
Speaker 3: But it's it's very true, and I feel like it
Speaker 3: has been a field of like taboo to talk about
Speaker 3: or to be excited about her be like it's really
Speaker 3: interesting or anything like that, and so it's discouraged interest
Speaker 3: in this really.
Speaker 2: Is gross, right, but it's also awesome. Yeah, I love it.
Speaker 2: That's pretty much the end of what I got. Aaron.
Speaker 3: Poop is gross. It is awesome. We love it.
Speaker 2: We love it. There's more to it we'll wash our
Speaker 2: hands after we poop, and.
Speaker 3: We we will certainly do that.
Speaker 1: Should we tell the people where they can read more
Speaker 1: shit about fun poop stuff?
Speaker 2: Fun poop stuff.
Speaker 1: There is so much more when it comes to a
Speaker 1: the history of sewers and be what people are doing
Speaker 1: about solving the poop problem. So there's a book by
Speaker 1: Lena Zeldovich, who if I interviewed for a book Club
Speaker 1: episode earlier this year for about phase therapy. But her
Speaker 1: earlier book is called The Other Dark Matter, The Science
Speaker 1: and Business of Turning Waste into Wealth and Health, really fascinating.
Speaker 1: Then by Steven Halliday, The Great Stink of London, Sir
Speaker 1: Joseph Basilgett and the Cleansing of the Victoria Metropolis, and
Speaker 1: then another book by him as well. But it's like
Speaker 1: an illustrated coffee table book for sewers and it's called
Speaker 1: An Underground Guide to Sewers or Down through and Out
Speaker 1: in Paris, London, New York. I love and it's it's here,
Speaker 1: it's it is honestly beautiful and really fun, and I
Speaker 1: loved it.
Speaker 3: It was great.
Speaker 2: I also actually had a book for this one. I
Speaker 2: never have books, but I did enjoy by doctor Pong.
Speaker 2: It's called Constipation Nation, which is such a good type title.
Speaker 2: I really did enjoy that book. I rarely read entire books,
Speaker 2: and I actually read that whole time thing. So that's
Speaker 2: how you know it was good and that there's like
Speaker 2: a lot more detail on constipation. I think there's even
Speaker 2: like treat your constipation smoothies at the end, which is
Speaker 2: hilarious to me. But then I also loved, oh this
Speaker 2: is or I have the citation for the paper. We
Speaker 2: actually mentioned the last episode about how it takes only
Speaker 2: twelve seconds to poop because I didn't get into like
Speaker 2: we spend so much time on the toilet.
Speaker 3: I mean, and that's related to hemorrhoids, and that's related.
Speaker 2: To there was a twenty twenty five paper that was
Speaker 2: like if you spend time on the phone, you're at
Speaker 2: higher risk of hemorrhoids. And I was like, there's so
Speaker 2: much to this, let's keep going right episode Anyways, that
Speaker 2: paper was from twenty seventeen. It was called the Hydrodynamics
Speaker 2: of Defecation, published in Soft Matter Soft Matter, and then
Speaker 2: I've got several papers on like the Global Prevalence of
Speaker 2: Constipation on FMT. I also have some more data on
Speaker 2: because we didn't get deep into this, but on colon
Speaker 2: cancer rates, and we're going to talk more about colon
Speaker 2: cancer later this season, so you can find all of
Speaker 2: it on our website, this podcast with killy dot com
Speaker 2: under the episode stap.
Speaker 1: You can thank you to Bloodmobile for providing the music
Speaker 1: for this episode and all of our episodes.
Speaker 2: Thank you to everyone here at the Exactly Right Studio.
Speaker 2: Thank you and Tom and Leanna and Brent and Pete
Speaker 2: and everyone who's involved in making this podcast possible.
Speaker 3: Pick Yeah.
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Speaker 3: Yes, thank you, Thank you. Well. Until next time, wash
Speaker 3: your hands, filthy animals,