Master Class on How To Fix Your Digestive Issues & Gut Health (With a Renowned GI Doctor)

Dr. Robynne Chutkan (00:19:13):

There are tons of things to do, but if I had to distill it down to three, I would say it's hydration, it's movement, and it's fiber and the movement, it's smooth muscle. It's not skeletal muscle, so it's not onto voluntary control, but we know that movement creates nitric oxide. And nitric oxide is part of what keeps the heart healthy and keeps the gut healthy. And so the movement stimulates peristalsis. If you don't have things moving through in a timely fashion, not only do you have symptoms like bloating and constipation, but you also have stasis of those intestinal contents and you have bacterial overgrowth because things aren't moving through. So the movement is really important. And I found that since pandemic so much, so many of us are so sedentary. I know that I'm not at the hospital a few days a week anymore, back and forth where I'm probably walking four or five miles every day. I'm sitting a lot more. And I think we've seen a huge effect of that, of the effect of being sedentary on the gut. So we need to stimulate gut peristalsis. The people we see with the worst GI problems are people in nursing homes. And it's not because they're elderly, it's because they're not moving.

Mel Robbins (00:20:26):

Wow.

Dr. Robynne Chutkan (00:20:27):

So movement is really key. Hydration, I can't say it enough times plumbing. We've got to unclog those pipes. And then the fiber, because the fiber feeds our gut microbes so they can ferment that fiber create all the healthy metabolites. And it doesn't have to be like some enormous kale salad. It can literally be grab a carrot as you're walking out the door and jump on it, throw an apple in your car, eat some nuts. Something basic, ideally something unprocessed. Right?

Mel Robbins (00:20:55):

I love how accessible this is because based on everything that you are teaching us, your body is naturally designed to work in the correct way. It is plumbing, it's trying its best. And so if you drink water, if you get all different kinds of plant-based fibrous foods in the research says try 30 different types of spices and foods and that. And if you simply walk more, you're saying that that's three things that we can do that will help over time create a healthy gut.

Dr. Robynne Chutkan (00:21:27):

Tremendous benefits. Tremendous. The water thing is like a drug when you really start to, and I was one of those people who for years walked around sort of dehydrated. I mean, I drink a lot if I was at heated vinyasa flow yoga or running. But other than that, I was like, I can't be getting up. I'm seeing patients. I don't want to get up every five minutes and have to pee. And then I started measuring and drinking a hundred ounces of water. I noticed a tremendous difference. I mean, I already have pretty good poos, I have to say. I brag. I'll show you some pictures later, mouth. Oh my God. But these, I mean just dramatic improvement and they perk up like how briskly they come out because things are lubricated.

Mel Robbins (00:22:10):

I really do want to dig into having you help us understand specific gut issues like bloating and IBS and some of the things that people really struggle with. But before we go there, I would love for you to explain to us why should we care about a healthy gut? And what I'm trying to ask is what is it impacting when your gut is healthy and when it's not? You said earlier that there's a big connection between your immune system and your gut health, which I didn't know. And so if you could just elevate this issue for us at the highest level, like why beyond our plumbing working? Does your gut health mean total health?

Dr. Robynne Chutkan (00:22:56):

The gut immune connection is probably the most important connection for the gut and other organs. You have the gut lining, and on one side you have the trillions of microbes in your gut, your microbiome. And on the other side you have the immune cells. And that gut lining is only one cell thick. It's a razor blade separating your gut microbiome from the immune processes. And it's a hand in glove relationship. They're working together. Literally the microbes are like the lookouts and they're like, oh, something problematic coming along. They trigger the immune system. In some cases, they actually kick on the lining of the gut. They push on it to trigger the immune processes. It's a physical interaction sometimes, but they signal the immune cells on the other side to say, oh, whoa, something big. Here comes Ebola or sars cov to two. You guys need to get ready, mountain immune response, start making antibodies, T cells mobilize.

Mel Robbins (00:23:53):

Let me just make sure I'm understanding why this matters, because based on what you're consuming through your mouth that gets processed through this 30 foot tube, your gut is extracting intelligence that mobilizes other parts of your body to help you outside of this tube.

Dr. Robynne Chutkan (00:24:12):

Absolutely. Your gut microbiome directs your immune system. It does. It literally trains it. And this is why we see there's a fascinating theory called a hygiene hypothesis, and it was developed by David str. He was an epidemiologist in Britain in the 1950s. He did a study of over 17,000 children from birth to adulthood. So a long period of time to figure out why they were seeing these high rates of autoimmune diseases in England and sort of post-industrial London. And he found that kids who were exposed to more germs who were living in large households where cousins and siblings were always sneezing and coughing on them, they were immunized because their immune system had been trained at an early age, how to differentiate between friend and foe and whether to mount an immune response or not. How high an immune response, kids who were super clean who were never sick, they had higher rates of autoimmune disease later on.

(00:25:11):

And Mel, if we look at a map of the world today, we still see the effects of the hygiene hypothesis. We still see high rates of autoimmune disease in countries where there are higher levels of sanitation, there's more washing, there's more chlorination, there are more chemicals. There are fewer microbes compared to less developed countries where people have close contact with animals, they have close contact to the soil, they're growing their own food. So the immune system needs exposure to microbes early on in order to train it so it can set it at just the right level. What we're seeing now in more developed countries like the United States is we're seeing an overactive immune system, which is manifest as autoimmune disease. One in four Americas, many people have multiple or allergies, food allergies, everybody's got an allergy.

Mel Robbins (00:25:58):

Why do we have a food

Dr. Robynne Chutkan (00:25:59):

Allergy because of an overactive immune system? And why do we have an overactive immune system? Because of what's going on in our gut? There is a very direct correlation.

Mel Robbins (00:26:09):

Let me see if I can explain this to myself. So you're basically saying that when your gut is out of whack, and it's getting all kinds of mixed signals, because if your microbiomes and the gut health isn't intact, it's actually not able to either break things down or read what's coming in correctly. And then that means it is not able to signal in an efficient and effective way to your immune system that either we got to go into battle or everything is okay. And so because our guts are out of whack, we're not getting the hydration, we're not moving, we're not taking care of ourselves and eating the fibrous foods. This is causing our immune systems to go haywire. Absolutely. And this is so fascinating, and I actually read somewhere, I don't know if this is true, that 80% of people that at least in the United States, that have an autoimmune disorder are women.

Dr. Robynne Chutkan (00:27:04):

Yes. Why does this impact so much Very high. And Gabor mate talks about this and other folks, we think it may have something to do with the effect of the female hormones, estrogen, progesterone, et cetera, and the interaction with the gut. And also because some of these genetic predisposes for autoimmune disease are sex linked, they're tied to the X chromosome. So a couple of different reasons. I also worry about the personal care products, the cosmetics, the other things that women tend to use more of that are getting absorbed into the body and how those might be affecting women. Because you think about it, you put makeup on at 10 o'clock in the morning, at 10 o'clock at night, it's like, where's the makeup? It's all gone. Where's it gone? It's got absorbed into our body. And again, I'm not saying that makeup causes autoimmune disease, let's be clear, but we put a lot of things on our skin. And after our GI tract, our skin is our next biggest digestive organ. Our skin literally digests the things we're putting on it. And so we have to also think, what are we putting on our hair, our skin, et cetera, that could be getting absorbed into our body that could potentially be triggering an immune response. So that's just one of several theories. And most diseases like cancer, like dementia, it's not one cause.It's multiple different factors.

Mel Robbins (00:28:19):

But is the researcher do you see in your clinical practice, if you are doing these interventions that anybody can do, drink more water, move your body, eat more like fibrous foods in your diet, when you can start to get your microbiome and your gut health and your plumbing working as it should, do you see an impact on an autoimmune disorder?

Dr. Robynne Chutkan (00:28:45):

Most of what I do in my practice now is helping people with complex autoimmune disorders like Crohn's and ulcerative colitis, get off immune suppressing drugs. And do you know how we do it, Mel? No. We do it with diet and lifestyle. And if you had told me 27 years ago when I finished my GI fellowship that I would be treating complex autoimmune diseases with food, I would've laughed at you. And I would've said, ha ha, that's hocus pocus craziness. But now when I think about it, I think about my colleagues saying to me, does that stuff really work? And I'm like, are you asking me as a fellow gastroenterologist if what you put into your gut affects what's going on in your gut? And you're asking me, is that how it, I mean, of course that's how it works. What we put into our gut profoundly impacts what's going on in our gut and what's going on in our gut profoundly impacts what's going on in the rest of the body. So it is very contrary to the prevailing wisdom of all the biologics and the immunosuppressants you see advertised on television. And that's a gazillion dollar industry. But I will tell you, Mel, we have published data on this and we have a success rate of about 79% getting patients off of these biologic treatments. Now, I will tell you it doesn't work in everyone and it's a cherry pick population because people are coming to see me, fancy GI Doc who they've got to travel out, whatever, come and see and they're motivated.

Mel Robbins (00:30:16):

But the intervention is what anybody could do.

Dr. Robynne Chutkan (00:30:18): 

The intervention is what anybody, it's drink or water, it's move your body. The intervention is not any special diet you have to go and buy or products. I mean, we sometimes do use this very high potency probiotic, the one I mentioned that has the indication as a medical food for IBD will often use that in conjunction, but it's always with dietary change. 

Mel Robbins (00:30:40):

What is the diet?

Dr. Robynne Chutkan (00:30:40):

It's similar to what I eat. It's a green smoothie in the morning. And I tell 'em, if you do nothing else, do this green smoothie, get in your three leafy greens, a little celery, the parsley and minter for me just for flavor, fruit, ice, little lemon for taste, get that in the morning. And I usually start people on about 12 ounces and then I work 'em up to 40 ounces of this green smoothie.

(00:31:03):

And it's all just stuff you buy at the supermarket. And I always felt like I was sort of alone out there in the wilderness saying, eat food, real food. It will make a difference. So green smoothie in the morning, and I tell people, look, if you're still hungry, have some eggs, make an omelet, definitely have something else for sure. And then for lunch, it's usually something based around plants. So I'll encourage my patients, I'll say, get a salad. That's usually easy for people to get. If you want some animal protein, go for it, but make sure it's a big salad. And ideally put some chickpeas in there, some hummus on the side, so lots of plants. And then for dinner, if you are an animal protein eater, your protein, your starch, your two veg plus salad, and that's it. There's a sensible eating and it's also getting people to cut down or ideally eliminate the ultra processed foods, the packaged foods with all the emulsifiers in my neck of the woods for autoimmune diseases in the GI tract, we see that the emulsifiers, the soy, lessin, carne in those things are particularly bad for the gut. And we think it's not so much a microbiome, but it's a gut lining

(00:32:13):

That they compromise a gut lining in some way.

Mel Robbins (00:32:16):

What are some other parts of your overall health that are driven by gut health that might surprise someone to know

Dr. Robynne Chutkan (00:32:26): 

Your estrogen levels? I did not learn this in medical school. When I found this out a decade or so ago, I was mesmerized by something called the ome. And the estrobolome refers to a collection of bacteria in your gut that metabolize estrogen. So when the estrogen is made primarily in the ovaries and a little bit in the adrenal glands, and it travels through the bloodstream to all the different parts of the body that have estrogen receptors. And that's not just the uterus, that's also heart tissue, different parts of our brain, et cetera, that have estrogen receptors. And then the estrogen that's not used gets transported. It gets into the bile and it gets excreted into the gut and it gets recycled through the gut. So there's certain bacteria in the gut that helped to recycle that. Some of it gets excreted out and some of it gets reabsorbed back through the lining into the bloodstream.

(00:33:23):

If the estrobolome is disrupted, you get higher levels of reabsorption than you should, and you end up with a situation called estrogen dominance where you have too much estrogen on board. And that is associated with a lot of conditions, with fibroids, with endometriosis, with a lot of the menopausal symptoms we think of, and again, this isn't the only reason for sure, but this is most people don't realize that the gut plays a huge role in estrogen metabolism. So if you've been taking antibiotics nonstop for whatever they may have been prescribed from decades. Decades, exactly. Not I had a strep throat, I took antibiotics, but somebody put you on antibiotics for your skin, told you you have a chronic inflammatory condition, maybe rosacea, take these antibiotics or because you're getting frequent urinary tract infections, take the antibiotics every time you have sex and that could add up depending on who you are.

(00:34:19):

So so many of the patients I see, and so many women in particular are put on these suppressive antibiotics not to treat an actual infection, but to treat inflammation or to prevent an infection. And that ends up being ruinous to your gut bacteria and that ends up affecting your estrogen metabolism and throwing your estrogen levels off balance. So I really, 

(00:35:17):

And the thing that I find in my patient population is it doesn't have to be a completely plant-based diet. Now Neil and his colleagues who are wonderful people would tell you that it should be, but we live in the real world and not everybody's going to become a vegan to control their hot flashes, but just eating more plants and eating a plant-based dinner, having your last meal before you go to bed, be primarily plants can help dramatically. If I want to induce a hot flash, I don't have 'em anymore, but if I want to induce one, I have a porterhouse steak and some red wine at night and I all night, I was going to say the same thing

(00:35:52):

Up all night.

Mel Robbins (00:35:52):

I was just going to say the same thing,

Dr. Robynne Chutkan (00:35:54):

Because digestion is such an active process, and particularly digesting animal protein that's high in fat, high in protein requires a lot of blood flow, a lot of enzymatic activity that leads to a lot of dilation and flushing. And of course the alcohol is going to vasodilate you too.

Mel Robbins (00:36:10):

I think you just inspired me to make a major change, especially during the weeks that I have a really big workload or I'm traveling for work, so I got to get up in the morning and give a big keynote in front of thousands of people. I always think, oh, I should have a steak tonight. I should have a piece of fish tonight. I should have a big protein thing to carry me through. And what I'm gathering from you is I would be way better off if I heavy loaded on the leafy greens and the vegetables and a lot of water at night because it would allow my gut to just flush itself

Dr. Robynne Chutkan (00:36:44):

Rest and rest and digest. Yes. And think about, I mean, the protein can be sat and it can carry you through, but think about having a high protein breakfast the day before. Have an omelet the day before or have more protein at lunch, but then for dinner, really lighten it up early and light super and salad. Perfect.

Mel Robbins (00:37:02): 

I love this because so many of the experts that have come on, because we've been talking to a lot of people about hormones and menopause, and for women in particular, how you age well so that you have energy and you're strong and you're able to be vibrant as you age. And so much of the message is about resistance training and just lots and lots and lots of protein. And so I think really trying to get the big protein in the morning and at lunch is the way to go. So I'm learning so much. 

Dr. Robynne Chutkan (00:37:42):

The gut brain connection is another fascinating one. I think gut immune and gut brainin right now, we have a whole separate nervous system in our gut called the enteric nervous system, and it's many, many millions of nerve cells. In fact, we have about seven times the number of nerve cells in our gut that we have in our spinal cord, not as much as we have in our central nervous system clearly, but the gut is a very innervated organ,

Mel Robbins (00:38:09):

Innervated?

Dr. Robynne Chutkan (00:38:09):

Lots of nerve cells.

Mel Robbins (00:38:11):

Okay, gotcha.

Dr. Robynne Chutkan (00:38:11):

It also communicates directly with the brain via the vagus nerve, the 10th cranial nerve messages going back and forth. The gut also is where most of the neurotransmitters are produced. Serotonin, the feelgood hormone, dopamine, several others, most of them are produced in the gut. They're co manufactured by bacteria.

Mel Robbins (00:38:31):

I think that is a surprise to most people because you hear the word serotonin and you think brain.

Dr. Robynne Chutkan (00:38:36):

Brain, yeah.

Mel Robbins (00:38:37):

But you're here to tell us, Dr. Robynne, no, no, no, no, no. Your gut health is critical because the serotonin that you need, most of it is manufactured in a healthy gut. In a healthy

Dr. Robynne Chutkan (00:38:47):

Gut. So what we see is that with a disrupted gut, we see abnormalities in mood, in cognition, in memory. And conversely, because it's bidirectional, it's gut affecting brain and brain affecting gut, we see the brain influence on gut motility, enzyme secretion, and absorption of nutrients. So you've got to have it in balance. And it's not either or. It's not either you take an SSRI or you eat healthily. It's both. But the idea that you can, and particularly for young people, the idea that you can take a young person who's struggling with mental health issues and they can be eating Cheetos and cheeseburgers while you're medicating them and you're not paying attention to what they're eating is magical thinking. We have to pay attention to that for brain health. Also,

Dr. Robynne Chutkan (00:39:44):

There are, and a lot of these conditions, it's multifactorial, but I'll give you just a basic example. There's a bacteria called campylobacter jejuni, which is a common cause of foodborne illnesses. And sometimes people will get it with a travels diarrhea when they're out of town or something in mice, if you inject a large inoculum of campylobacter dei, you induce anxiety in mice. What's a human correlate for that? Post-infectious irritable bowel syndrome, which is what we refer to when somebody has a change in bowel habits that's happening after an infection, often after an infection like campylobacter, jejuni, post-infectious irritable bowel syndrome doesn't just affect your bowel habits. Where now the bowel habits are irregular, maybe they're looser, they're more frequent. It also frequently involves changes in mood. People will say they're more anxious. I went to the Caribbean. I got travelers diarrhea. I was in Mexico, I got Montezuma's revenge, and I came back and my bowel habits haven't been the same, but I also find I'm more anxious. My mood seems to have changed. And we think a lot of that is mediated through the change in the microbiome.

Mel Robbins (00:40:55):

Wow. Let's talk about IBS because I have a number of friends and family members that are struggling with it. So what should somebody do if they think they have IBS? What would you say? These are the steps I would take before you go running for some sort of drug.

Dr. Robynne Chutkan (00:41:09):

Number one is you have to figure out what is causing it. And I like to think in terms of general categories. So is it something mechanical? If you're a woman, when was your last ultrasound? You have a big fibroid. Could there be endometriosis? Do you have an verted uterus or a prolapse bladder or something that's pressing on it? So what is the anatomical mechanical thing going on that could be symptoms. Medicine cabinet is a big one, and it's not just prescription drugs, but it's also over the counter and supplements. So you need to look at the side effects and what am I looking for? All of them. You're looking for things that have GI side effects, nausea, vomiting, diarrhea, constipation. And isn't that every medication? It's a lot, but I'll tell you when they list side effects, they list the most common ones first, it's like ingredients at a food label. So the most common ingredient is listed at the top.

Mel Robbins (00:42:02):

And by common you mean this is the side effect we see the

Dr. Robynne Chutkan (00:42:05):

Most. Exactly. Okay. Yes. So if you see nausea, vomiting, abdominal pain, constipation, diarrhea in the top five, and you are having some of those symptoms, that's something that's worth checking out. And again, not advocating that you take a drug holiday on your own, but talk to the prescriber. And here's the thing, your psychiatrist might be prescribing a drug for you for anxiety, and the drug may be helping your anxiety, but it may be causing a whole different problem in the GI tract. I have to remind people that just because something is helpful doesn't mean it's a good idea. And I tell people all the time, if you're tired and I gave you some cocaine, it would pep you right up. But does that mean cocaine is a good idea for treating fatigue? So in my practice, I spend so much time trying to undo medical misadventure, I like to call it, where a very well-meaning physician prescribes something for his or her neck of the woods, a kidney problem, a psychiatric problem, a lung problem, and it's going great for that problem, but it's messing up my organ now.

(00:43:12):

So we're very siloed in medicine. The nephrologist is the kidneys and the pulmonologist is the lungs, and everybody's just sort of focused on their thing. And because the medicine cabinet is such a problem in the GI tract, and as you said Mel, but don't all these drugs have GI side effects? Many of 'em do because you ingest them. So they potentially affect the pH of the gut. They potentially affect the gut lining and they potentially affect the gut microbiome. And then those things affect the immune system, et cetera. So it becomes a sort of whack-a-mole. Like you whack one problem here, your high blood pressure, fantastic blood pressure is controlled. Now we have a problem over here. So we whack that with another medicine. And so it's polypharmacy. And when I see people, the first thing I want to figure out is, is this a side effect I'm treating?

(00:44:00):

Because it often is. So is there constipation or they bloating a side effect of a medication they're taking? And the sometimes challenging thing is people don't want to hear that. They want the magic potion. Give me the magic supplement probiotic that's going to make the cell go away. So I have people bring their medications, they're over the counter, the supplements, everything, and I lay 'em all out on the table. And the people in my office always laugh because I always have my rubbish bin right next door. They're like, oh, this is going to fill up. And I'm like, okay, this one, what's this one for? And to be clear, I would never tell somebody to stop a prescription medication that I didn't prescribe. I tell 'em, this one you got to talk to your prescriber about. But I divide it up and usually by the time I'm done, it's a pretty small group that's left.

Dr. Robynne Chutkan (00:44:48):

You got it. The nonsteroidal anti-inflammatory drugs.

Mel Robbins (00:44:50):

What is that?

Dr. Robynne Chutkan (00:44:51):

Advil, cin, Aleve, ibuprofen. So when we look at the emergency visits for gastrointestinal bleeding, number one, cause too much, too much ibuprofen.

Mel Robbins (00:45:04):

Wow.

Dr. Robynne Chutkan (00:45:05):

People don't realize that over-indexing on this stuff can cause fatal gastrointestinal bleeding. There was not a weekend on call when we were not in the intensive care unit with our scopes trying to stop dramatic near fatal gastrointestinal bleeding. So these drugs can be potentially really dangerous. You have to be careful with them.

Mel Robbins (00:45:28):

And I'm assuming that if this is kind of the detective work you're doing that it's still the same three things that you would recommend in terms of movement and water and diet to overcompensate.

Dr. Robynne Chutkan (00:45:38):

But you can't fill a bathtub with a stopper out. So if you're trying to improve gut health, fill the bathtub, you have to make sure that it's stopped up, that you're not draining all the good stuff you're doing out. I like this concept of personalized medicine, but personalized medicine, not in the sense of all these wonky tests and supplements, but personalized medicine in terms of sitting down and really figuring out what are the things that you are dealing with and what is a background noise? What is a platform on which your symptoms or illness live?

(00:46:15):

Is that platform standard American diet only ate a broccoli floret once a week as you're only vegetable? Is it massive amounts of antibiotics in childhood? As was the case with my daughter, is it really sedentary and no time outside? So you've got to look at that platform, see what you can change, and then start to add on. You don't just start adding on all the medication without really, and even thinking about the other medication, how are these four other medications you may be taking for high blood pressure or something else? How are they affecting the liver?

Mel Robbins (00:46:52):

I think this is so amazing because I hope as you're listening to Dr. Robynne, you're waking up and realizing if I can get the three kind of main things, it probably creates a foundation for better health overall, which helps me sort out what I should be doing and what I shouldn't be doing. So Dr. Robynne, here's where I want to go next. One thing that I want to talk about with you today is poop. What should we be looking for? What's healthy, what's not

Dr. Robynne Chutkan (00:47:18):

My favorite thing to talk about? And Mel, I am so curious about your poop if you are willing to share. I know I'm not the only one who wants to know what are Mel Robbins bowel habits like?

Mel Robbins (00:47:31):

Well, I am the kind of person you asked the question. I'm going to tell you. So I'm happy to talk about my poop.

Dr. Robynne Chutkan (00:47:37):

I have a feeling that you have wonderful poos because you have this glow. You seem really healthy. Do you really want to know? Yes,

Mel Robbins (00:47:42):

I really want to know. So I am a once a day person.

Dr. Robynne Chutkan (00:47:46):

Excellent.

Mel Robbins (00:47:47):

I typically go in the morning and I have one of those little stools, the

Dr. Robynne Chutkan (00:47:53):

Squatty potty

Mel Robbins (00:47:53):

Tip that you put up. And if I can't find a stool, if I'm at a hotel, I pull the little garbage can over and stick my feet up. I have a very, I think it's healthy. I mean, I don't even know what healthy poop is. I just know that when it comes out kind of in one shape,

Dr. Robynne Chutkan (00:48:12):

Perfect

Mel Robbins (00:48:12):

And it's somewhat soft and held together and there's not a lot of strange objects in it that that's probably healthy. I don't like it. If I have a situation where I'm not doing well and I'm super stressed, I might go a day without pooping, but typically never more than a day or two. And then when that happens, it looks like melt duds, and I know I'm in trouble and I'm not healthy. How am I doing doc

Dr. Robynne Chutkan (00:48:39):

Stool Nirvana baby? Is that what you got it? Stool Nirvana. You hit all the so daily color formed, and it also sounds like you feel good when it comes out, right? There's that feeling of like, yeah, I emptied. I detoxed. I'm good to go. And

Mel Robbins (00:48:54): 

I'm pretty efficient. I don't spend a lot of time in there. I can get in, I can get out. But that does beg the question, 

Dr. Robynne Chutkan (00:49:05):

How often do you eat? Do you eat every day? Of course, at least once a day. Yes. You should be eliminating once a day. So this idea, we have this textbook definition that it's three or more bowel movements a week is normal, but if you're going under three, you're constipated. It's a very arbitrary number. And when we think about constipation, we're usually thinking about things like consistency. Is it stool hard or is it soft? How much is coming out? But it should absolutely be a daily thing because that's what it is. It's elimination. It's eliminating dead blood cells. It's an eliminating bacteria, toxins, et cetera. Undigested food particles, that stuff is not supposed to be gumming up your cola and just sitting there,

Mel Robbins (00:49:43):

Right? Everybody that does not go number two once a day just leaned in and thought, oh gosh. Well what do I do? So if you're somebody that is not going once a day, that doesn't have kind of a satisfying experience with this or kind of reliable, what are the first couple steps that you want somebody to do?

Dr. Robynne Chutkan (00:50:07):

I think the first thing again is recognizing that this should be daily. Now that being said, if you skip a day here and there, you're traveling schedule is a little bit different. That's nothing to worry about. But how can we help people go every day? So I want people to consider a couple things, what they're putting in, how they're stimulating the gut, and that's primarily with movement and what they might be doing that's slowing things down the gut motility. So what you're putting in, you want to make sure you're putting in enough fiber, you want to make sure you're putting enough water, liquid, it's plumbing. The GI tract is pipes. In fact, a plumber was at my house one day fixing something and I was standing over him and he kept looking at me and he was like, are you checking what I'm doing? I'm like, no, no, no.

(00:50:48):

We're just in the same business. You just make a lot more money than I do. So I'm just looking at what you're doing here. But it's plumbing. It's one long pipe from north to south, about 30 feet long and things get clogged along the way. And what do you do when your pipe is clogged? Thin? Liquids. Lots of water. So I tell people my rule of thumb, half your body weight in ounces of water as a minimum, and that's just plain water. We don't need electrolytes in it, we don't need flavoring. Those things often are irritating to the gut. So just plain water, half your body weight in ounces of water as a minimum, and that makes a tremendous difference. I can probably solve 50% of the constipation I see in my office just by getting people to hydrate. And by the way, as you know, great for your skin and everything else. So many of us are walking around dehydrated.

Mel Robbins (00:51:36):

So takeaway number one for me already is thinking about your gut system as a 30 foot long plumbing system. It starts with your throat moves all through your body and right out the shoot at the bottom. Absolutely. And that half of your body weight is what you should be hydrating with just plain water every day. And as a medical doctor specializing in this, 50% of constipation issues can be solved by simply hydrating correctly.

Dr. Robynne Chutkan (00:52:06): 

I mean, it's a generalization, but 50% of the people I see in my office who are bloated and constipated and things are sluggish when I get them to really start hydrating things park right up. 

Mel Robbins (00:52:24):

And

Dr. Robynne Chutkan (00:52:24):

That's because of three main reasons. So if you have had a colonoscopy, if you're 45 or over, you should have had a colonoscopy. And you may have been told, particularly if you're a woman, that you have either a redundant colon or a tortuous colon or a twisted colon. And the reason that's more common in women is because of anatomical differences. So number one, we have a longer digestive tract. Our colons on average are about three to five inches longer.

Mel Robbins (00:52:52):

Why?

Dr. Robynne Chutkan (00:52:53):

Well that first of all, it may not seem like a lot like three five inches days, a lot, five inches. If you think five inches, that's from your rear end of your belly button basically. Exactly. It is a lot. And that extra length creates more looping and twisting. And so things are more likely to get stuck. And that's one of the main reasons women tend to be so much more bloated and constipated. The reason why is to allow for more fluid absorption during pregnancy. So fluid, the colon does two things. It gets a products of digestion from north to south. Well, it does more than two things, but two big things. And then it also reabsorbs water from the inside, from the stool through the lining of the colon into the bloodstream. So the reason that women have a slightly longer colon is so that when we are pregnant, we can reabsorb more water through the colon to maintain the amniotic fluid.

Mel Robbins (00:53:41):

Let me just see if I can extract that so that those of us, without your amazing medical knowledge and degrees understand this. I think that's fascinating. So did you just say that one of the things that your colon is doing is when the waste is moving through your colon, the colon is actually removing water and moisture from the waste matter and recycling that water through your body so that as a woman you can make the amniotic fluid, you can do other things that are part of the reproductive cycle?

Dr. Robynne Chutkan (00:54:20):

A hundred percent. And so if you were to go up into a colonoscopy, as somebody is having a bowel movement, which I don't recommend, we like to have the colon cleaned out when we're doing that, what you would see is that when the stool hits the top of the colon, it's liquid. What? It's liquid and it's green, it's ous fluid. And as it moves through the five to seven feet of colon at the end, the fluid gets reabsorbed. So that what comes out at the end is a beautiful Mel Robbins stool, Nirvana, chocolatey brown, gorgeous. We need to make some t-shirts for you that say, I have great poops. Oh my God. Like someday.

Mel Robbins (00:54:57):

I dunno if I want people looking in the toilet and going that looks like Mel Robbins right there

Dr. Robynne Chutkan (00:55:01):

That's a Mel Robbins special

Mel Robbins (00:55:03):

Smiling right back at you, yes

Dr. Robynne Chutkan (00:55:04):

So at the end you get this chocolatey brown thing. So how do you liquid green at the top of the colon to solid brown at the bottom. The colon reabsorbs the fluid and all the bacteria that are primarily in the colon, you have bacteria throughout your whole GI tract, but they're concentrated at the bottom. The bacteria get dumped in the dead bacteria and the dead red blood cells and that turns it brown. And so that process happens in the colon. The absorption of nutrients, the vitamin A, D, E, and K, the iron, all that stuff gets absorbed upstream in your small intestine. So the function of the colon transport the products, reabsorb water, ferment the products of digestion with all the gut bacteria so that you end up with a chocolatey brown stool.

Mel Robbins (00:55:48):

This is fascinating.

Dr. Robynne Chutkan (00:55:49):

So the longer colon is just reason number one. Reason number two, why we're more bloated and constipated is that we have a deeper, wider pelvis. The female pelvis is called a OID pelvis and the male pelvis is an Android pelvis. What that means is that our colon falls deeper down into the pelvis where it has to compete for space. What else is in the pelvis? Your uterus, your fallopian tubes, your ovaries, your bladder, that's a lot of hardware In men. They just have a prostate gland that's about the size of a walnut. So there's much more room. If you look at two skeletons side by side, male and female, you can tell the female the pelvis is like wings and the male is straight. And again, what's the reason? Childbearing so that we can accommodate a whole human being down there. So that's reason number two. So these are both sort of anatomical reasons, right? Longer, deeper, wider pelvis. Reason number three, we have lower testosterone levels. Okay, well what does that mean? Testosterone does a lot of things and again, it's not that we don't have any but we have less. And one of the things testosterone does is it makes the muscles in the body kind of stronger, more rigid.

(00:57:00):

So men have a tighter abdominal wall because they have more testosterone. So even a man with a big bare belly, he'll complain about having a bare belly, but he won't complain about being bloated because underneath his bare belly is a nice tight Spanx. And we've got a stretched out Spanx because of the lower testosterone levels. So these three things really conspire to bloat and constipate us. And if you look at the medical literature, you'll see all these articles about why colonoscopy is harder. In women, it takes longer, we require more sedation, and that's true, but it's not because we have a lower pain threshold. It's because we have all these anatomical things that are there for a reason. They're not a design flaw, but they also conspire to make us more backed up.

Mel Robbins (00:57:45):

Can we talk a little bit about constipation?

Dr. Robynne Chutkan (00:57:48):

I love talking about constipation.

Mel Robbins (00:57:49):

Why do you love talking about constipation?

Dr. Robynne Chutkan (00:57:51):

Constipation is so satisfying because there's so many different things that cause it, and often people are dealing with two or three things and when people feel better it's like they're so happy. And the other reason I love treating constipation, sorry to interrupt, is because bloating is constipation's fellow traveler. And so when people are constipated, they're almost always bloated because they're just plugged. And so when you relieve the constipation, you de bloat them and they're thrilled. And the other thing is a lot of people who are bloated don't even realize they're constipated. You can have a bowel movement every single day and still be constipated. You can have two bowel movements a day and be constipated if you are having something called incomplete evacuation, tenus and tenus is like the new insomnia. So think about it. When we think about insomnia, we think, okay, I have trouble falling asleep. But most people who have insomnia don't have trouble falling asleep. They go to sleep fine, but they wake up and they can't go back to sleep. I mean I know that's my issue. I go right to sleep and then I pop away and I start ruminating and I can't go back to sleep. Well, constipation, tenus is kind like that. It's not that you're not going, you're having a bowel movement, but it's incomplete and you can tell that your colon isn't empty. You've got that,

Mel Robbins (00:59:09):

that kind of feeling like, okay, there's something,

Dr. Robynne Chutkan (00:59:10):

I still got something on the launchpad. And often it's a smeary wipe because when you wipe and there's still a lot of stool on it, that's because there's stools still in the rectum that hasn't come out. So you don't have that good clean wipe where it's like, oh look, nothing on the toilet paper. That's part of stool Nirvana is a clean wipe.

Mel Robbins (00:59:27): 

You said that there were lots of different causes and lots of different things you can do. 

Dr. Robynne Chutkan (00:59:36):

It's very similar to the irritable bowel syndrome to the IBS classification. So mechanical, do you have a voluptuous venous colon? Do you have fibroids? Have you had surgery and you have scar tissue? Do you have a prolapsed bladder or rectum? So what's going on mechanically? Medicine cabinet, I think I beat that horse to death. And then hormones, do you have potentially undiagnosed hypothyroidism? Are you early menopause and now you're more constipated because of that? And remember, perimenopause starts like 10 years before you stop having your period. So could it be a hormonal problem? Could it be a physiological motility problem? And the motility is very tied to the composition of the gut bacteria. So believe it or not, antibiotics that you took 10 years ago and affected your microbiome can now be causing your gut to slow down or go too fast and not function properly.

Mel Robbins (01:00:32):

I have somebody that I love that is chronically constipated and we'll go four or five days and that is consistently what their experience is.

Dr. Robynne Chutkan (01:00:44):

And what do you think the reasons are? Have you done any sleuthing

Mel Robbins (01:00:47):

Too? I have. And it's a very healthy person. Exercises all the time, has a very clean diet, does not take not a lot of medication young. And I personally think it is an issue with the muscles and not somehow training yourself to clench when you should be releasing.

Dr. Robynne Chutkan (01:01:13):

It's a huge category and I'm so glad you brought it up because I had overlooked that when we were talking about it. So can you describe what this means?

Mel Robbins (01:01:20):

Because I think for people that also have, you're shy about pooping

Dr. Robynne Chutkan (01:01:23):

People, it's eye bowel. The medical terms are things like in isus and some of these are pelvic floor issues and I know you've had pelvic floor people on, but it is tightening when you should be releasing. And what we're talking about here now isn't really a pelvic floor issue. It is a muscular issue. And it's exactly what you said, shy bowel, the technical term is reis. It's also called psychogenic fecal retention and it's classified as a psychiatric problem. But there's some really important physiological things that make me think it's misclassified as a psychiatric problem.

Mel Robbins (01:02:00):

So could somebody have constipation and you actually have shy bowel get hundred percent, you get in there and you're so constipated and you're like, why can't I get so common? And then as you're stressing and tensing, you're actually in this almost traumatic response to pooping because you're so stressed about being constipated. Is this like

Dr. Robynne Chutkan (01:02:20):

A thing? Well, it's the immediate stress, but more so it is what happened before. So people who tend to hold their poo in,

(01:02:28):

So you have to have a bowel movement, but you're in the subway and there's not a good bathroom or you don't have time, you're at the airport and you're worried that your flight's going to board without you or you're at school and the bathroom's gross and there's space between the door and people can see and hear and smell and there's noise associated with it. It's one of the most important things for bowel hygiene is to not have stalls because even people, I am the least shy about bowel movements, but I mean I don't want to have a bowel movement in public, but I don't care. I'll be in the stall talking to you. That's not really normal. Most people do not want to be in a bathroom with four stalls having a bowel movement talking to somebody on the other side of the door. They're like, no, they want privacy. Having a bathroom where you have a toilet and a door that closes and not stalls hugely helpful for good bowel habits because a lot of people will be comfortable going to the bathroom in that setting. So you have these two muscles. You have the internal sphincter, which is under involuntary control,

Mel Robbins (01:03:30):

Meaning it's going all the time.

Dr. Robynne Chutkan (01:03:32):

It's pushing out, it's clenched tight, it's clenched tight to prevent leakage.

(01:03:35):

And then you have the external sphincter which is under voluntary control. And that's a wand that you open or close depending on whether you're trying to push a stool in or out. Now when the rectum fills with stool, the internal sphincter relaxes to let the stool out and that's when your external sphincter is supposed to push it out. But if you decide, oh, this isn't, I don't like the look of this bathroom, I'm at a train station, I'm going to wait. You are clenching when you should be releasing. And that completely confuses the sphincters. So you can train

Mel Robbins (01:04:08):

Yourself to hold it in and not realize you're doing

Dr. Robynne Chutkan (01:04:10): 

That a hundred percent. So that creates something called reverse peristalsis where the stool is going back up in the wrong direction instead of coming out. And so if you do that often enough, and often this happens in children, it's more common in girls, we tend to be a little bit more fastidious about where we use a bathroom. If you do that often enough, it means that when you actually want to have a bowel movement, you can't because the sphincter is confused like the internal sphincter relaxes, but now the external sphincter is clenching. 

Mel Robbins (01:05:29):

So how do you know if you're bloated versus you're just gaining weight?

Dr. Robynne Chutkan (01:05:35):

Yeah, that's a really challenging and sometimes uncomfortable conversation to have with people. But a really useful way to know is to take a tape measure and measure right around your waist, generally just around your belly button in the morning and at night, every day for about a week. If there is a lot of variation in that number, that's likely bloat because bloating ebbs and flows and it's usually gas, but it can also be liquid and solid. If it is belly fat, that number typically won't vary by more than an inch. And sometimes people come and they have an apple shape, skinny legs, big belly, and they think they're bloated. And on exam I can also tell because fat feels different. And when you auscultate and you percuss and tap and you auscultate and listen, I can tell fat from gas, but if somebody's out there and they're not at the doctor measuring the waste and seeing if it ebbs and flows and people will send me pictures and typically it's flat to fat from morning to night. So they're flat in the morning and then they send me pictures at the end of the day and they're super bloated.

Mel Robbins (01:06:44):

What are some surprising foods that cause bloat that we might not know? Cause bloat.

Dr. Robynne Chutkan (01:06:50):

Yogurt. Yogurt,

Mel Robbins (01:08:06):

Are there some surprising everyday non-food things that can cause you to be bloated?

Dr. Robynne Chutkan (01:08:10):

Yes, there are. One of the things to remember with bloating, I mean we think about the GI tract and elimination and stool and liquid and gas, but it's also our lymphatic system. And our lymphatic system is like a fluid that bathes our cells and it has to drain. And exercise is what stimulates lymphatic flow. So if you're sitting for a long time and you may notice it just if you're sitting for a long time, your feet swell, why do your feet swell?

Mel Robbins (01:08:36):

I don't know.

Dr. Robynne Chutkan (01:08:36):

Because the venous flow, the veins are occluded because you're sitting and there's pressure on the veins and the lymphatics don't move as much. So moving around exercise, really important for the lymphatic flow, really important for de bloating. And then there's things like salt in the food. Alcohol and alcohol is a big one because it irritates the gut. That can lead to inflammation, that can lead to fluid retention. It also dehydrates us and then that causes fluid to shift and puffiness, things like that. But exercise is another big one for bloating.

Mel Robbins (01:09:12):

When somebody comes and sees you, Dr. Robynne and they just are really, really bloated and it's not a big serious issue, it is something that they're experiencing. Is there a step-by-step protocol that you're like, do this and do this and you should be feeling relief in a matter of days?

Dr. Robynne Chutkan (01:09:29):

I love putting people on a liquid diet for a couple days and using some magnesium citrate. Now I want to say with the magnesium citrate in the liquid, the bottle, you got to make sure there's no kidney disease and other things going on. But let's say this is a typical healthy person. They went on vacation, they over sported themselves. In the words of my mother-in-law, they ate a little too much. They drank a little too much. Most of us come back from vacation feeling a little constipated.

Mel Robbins (01:09:57):

Why is that? It's because we've just been like, Woohoo.

Dr. Robynne Chutkan (01:10:00):

It's because we've been woohoo. And also if we've crossed time zones that we often feel jet lag in our gut, it slows down. And also because our GI tract is a creature of habit. So now you're in a strange bathroom somewhere. And so our bowels get a little shy when we're traveling. So my favorite thing in that situation is to put them on two days of a clear liquid diet, which could be broth and tea and green juice as opposed to a smoothie and do that for a couple of days and a little bit of liquid magnesium citrate at night, not too much. We don't want to blast things' a like a teaspoon. No, no, no. The typical bottle of magnesium citrate is about a soda bottle. So maybe a quarter of that,

Mel Robbins (01:10:40):

A quarter of it, a

Dr. Robynne Chutkan (01:10:40):

Quarter of that. So like a cup of the liquid magnesium citrate. Make sure if you haven't taken that, that you know where the bathroom is because magnesium citrate, for some people it will work overnight and for some people it could work

Mel Robbins (01:10:52):

Like right now

Dr. Robynne Chutkan (01:10:52):

In a couple hours. So I like that because again, the stimulant laxatives that have senna, things like that, those are really hard on the colon, can become dependent. Some of 'em have an impact on the microbiome that isn't great. But the liquid diet, that is a great way to reset, to decompress. Most of the time when your colon is uncomfortable, stop eating liquids, it works great. And you see with animals in the wild when they're sick, they stop eating. You won't see a dog who picked up a parasite chowing down on their food. In fact, that's often how we know they're sick. Like in addition to the fact that we're looking at their stool, they're not eating. So that is still really helpful, what we call NPO, nothing per orum, nothing by mouth, and it doesn't have to be that extreme, but going to liquids and eating less to allow whatever it is to come out. And that could be true even for something that's infectious. If you have a mild case of infectious diarrhea, a foodborne illness, and your GI tract is trying to expel that and you're having diarrhea and you're vomiting and it's trying to eliminate it, don't go adding a whole bunch of food on top of that and make it harder. If your GI tract wants to empty, let it empty, get it all out and then start again. So that's my favorite thing is just to do a little mini cleanse.

Mel Robbins (01:12:12):

How does stress impact our gut?

Dr. Robynne Chutkan (01:12:15):

Stress has a huge impact on our GI tract. So we talked about the gut-brain connection and the neurotransmitters, et cetera, but stress triggers our sympathetic nervous system, and that's our fight or flight. A parasympathetic nervous system is our chill out, rest and digest. So if you think about having to get away from the tiger that's chasing you, you need the blood flow to go to your brain and the large muscles in your body, your quadriceps, your hamstrings so that you can run and get away from danger. Digestion itself is a very active process. It takes a lot of enzymatic activity, a lot of blood flow. So when you are stressed, all the resources are diverted away from your GI tract. And so stress can really impact digestion negatively because it will affect not just the way the digestive enzymes are secreted. It can decrease acid secretion, it can decrease other digestive enzyme secretion, but we know stress can also increase the population of unhealthy microbes.

(01:13:19):

There was a famous experiment that was done in college students and it found that during finals, certain more pathogenic bacteria could increase a thousand fold in an hour, just start multiplying and multiplying and multiplying. And you think about when college students are stressed, they're not sleeping, they're not eating well, they're over caffeinated, and now their microbiome is out of wax. So stress has a really profound impact. The question comes up a lot, Mel, with people who have irritable bowel syndrome, particularly folks where there hasn't been one or two more specific causes found and they want to know, well, is stress causing this? What I find in the GI tract is stress isn't usually the entire reason, but it can be a really major contributing factor.

Mel Robbins (01:14:02):

What are symptoms that indicate that there may be something more serious going on with your gut? Dr. Robynne?

Dr. Robynne Chutkan (01:14:09):

Red flags in the GI tract are really important. And those would include things like blood in the stool, weight loss, vomiting, abdominal pain, not like a little discomfort, but like a ooh, that really hurt. Those are the things, unrelenting, nausea. Those are the things that I would say get the to a gastroenterologist. And quickly for those things,

Mel Robbins (01:14:33):

Dr. Robynne, you have this 10 day plan for a better gut, and you call it the gut bliss method. Will you walk us through it?

(01:15:47):

And then the restore is how do you restore overall health? And a lot of that focuses on mind body practices, on getting outside, on getting quiet, reducing stress. And of course hydration is a big part of it. So it's simple. It's stuff that anybody can do. It's not expensive. I mean, you need access to some good food and you need to actually eat it. But what I find, whether I'm seeing a patient who has complicated Crohn's disease or somebody who's just a little bloated, it is incredible how much of a difference these basic principles make. And I came up with them over, it's been a couple of decades of practice. And not to say that some of the fancier things don't play a role also, right? But what I find the majority of the time, it's really getting people to pay attention to these foundational things that they can do.

(01:16:37):

These are not things that require a gastroenterologist. I mean, you may need to go to the gastroenterologist for the evaluation for sure, particularly if you have alarm symptoms. But these are things that anybody can build into their everyday routine. And I know that it doesn't sound super sexy. Well, where's the fancy magical food and supplement? But believe me when I tell you, Mel, I have done thousands of colonoscopies, seen thousands of patients in the 30 plus years since I graduated from medical school. And these are the things that make difference. And the beautiful thing is you can see a difference quickly. You may not be able to reverse your autoimmune disease quickly if that's part of the goal, but in terms of that tangible return on investment that your gut is going to give you when you sit down and you have that stool nirvana for the first time and you're like, damn, is this what it's supposed to feel like? I just detoxed in the most profound way.

Mel Robbins (01:17:34): 

I freaking love you. I feel so smart, and I literally want to go to the bathroom now. You're so smart and just enjoy having a poo. I would love Dr. Robynne for you to talk directly to the person listening because you have been so generous and have poured into us. There was so much that you taught us that you equipped us to be able to do.

Dr. Robynne Chutkan (01:18:09):

Eat more plants. Eat more plants. You don't have to be vegan or vegetarian or any of it, but plant fiber is the most important food for our gut microbiome. It doesn't mean they're not other things that aren't helpful, and it doesn't mean the other stuff you're eating is bad, but we have to feed our microbiome. We have to nourish and nurture it, and we do that with plant fiber, whether it's just a carrot steak as you're going out the door or an apple that you throw in your bag or it's more complicated. Lentil bowl, eat more plants.

Mel Robbins (01:18:41):

Dr. Robynne, I often remind everyone that some of the best people that you will meet you haven't met yet. And I just love you. Love I feel love. You too feel literally walked into my life and we are going to be lifelong friends.

Dr. Robynne Chutkan (01:18:55):

And for the record, you already super smart. Before I walked in here, you already knew so much stuff. People need to understand how their body works. We're kind of alienated from our body and we're really alienated from our gut. We don't even want to look in the toilet. I'm like, how can you not look in the toilet? It's like tea leaves. It's telling you something. This is really important evidence and feedback. You can't just flush it and ignore it. And we do that because we still have this sort of Victorian sensibility about cleanliness and stool and it's dirty. And so really understanding how this stuff works, and for me, helping people to understand, and this is really the focus of last book, the antiviral gut that yes, our gut is a digestive organ and digestion is really important, but our gut is also a defensive organ. Stomach acid isn't just there to digest food. It also kills pathogens. Our gut lining literally protects us from pathogens so that bacterial viruses can't penetrate and get into our bloodstream and travel to the rest of our body. Our stool eliminates not just waste matter, but toxins. So there's a huge defensive element to our gut. And if we want to stay healthy, we got to keep these defenses going. We got to protect these defenses and understand them. So I'm so grateful to have a chance to come on and explain all this stuff.

Mel Robbins (01:20:15):

I'm so grateful that you're here. And so the person that was listening to us didn't just feel smarter, they felt seen. They now understand themselves. And more importantly, you know what to do and you know why this can work and why it matters, and that means somebody's going to try it. The simplicity of it is also something that I really love because let's face it, we're all busy. If you can't fit it into your already crazy, busy life, you're not doing it. If you can't remember it, when you stop listening to the two of us, you're not going to be able to do it. If you can't share it with your friend who has irritable bowel syndrome or your son or daughter or your husband who has a problem with constipation, if you can't remember what to tell them and why it matters, you're not going to be able to help.

Dr. Robynne Chutkan (01:20:59):

Absolutely.

Mel Robbins (01:21:00):

And so I appreciate spending this time with you. I would sit next to you in a public bathroom and open stalls and chitchat all day. And so thank you. What are your parting words?

Dr. Robynne Chutkan (01:21:14):

I want people to remember that when they have these symptoms in the GI tract of bloating and constipation and heartburn, so often these are not illnesses that are just falling out of the sky. This is your gut trying to communicate with you. It is knock, knock. In the case of heartburn, why did you have that porterhouse steak at 11 o'clock last night? And the two glasses of red wine? You should have that at one o'clock, had a salad at night. So it is your GI tract giving you feedback. Why is it giving you feedback to keep you alive, to keep you healthy, to protect you, to try and prevent you from doing it again? But what do we do? We don't listen. We just block acid and keep on going. Now, there are of course these alarm signs, right? Blood and severe pain and so on.

(01:22:01):

But most of the symptoms, the common symptoms, the indigestion, the constipation, the bloat, these things, it is your GI tract saying, knock, knock and try to communicate with you. And my whole goal is to translate the stuff to basically teach people gut language. Let me tell you what your GI tract is saying and how you can respond. And once people do that, they don't need me. And that's the goal, right? I'm superfluous. I'll just see you at the farmer's market. Hey, what's up? Or in public bathroom, exactly. We'll be chatting. You should not. If somebody is continuing to come and see me year after year after year, aside from chronic autoimmune diseases, it means I'm failing. I'm not doing my job. If I were seeing you for constipation 10 years ago and you're still constipated, you should fire me because I needed to have given you the tools I needed to have translated for you so that you now speak gut ease and you understand and you know exactly what to do.

Mel Robbins (01:22:59):

Dr. Robynne, thank you. Thank you, thank you. And thank you for tuning and for sharing this. I know you're going to share this with so many people in your life. Didn't you freaking love her? And for the record, I would be next to you in a public bathroom stall too, talking off my whatever with you because I love you. I believe in you. And what I'm so excited about is you now have world, world-class medical facts and understanding from literally the number one expert on this. So you can empower yourself from the inside out to activate the natural intelligence of your body, and you now know all the health implications and how positive it is. So go do it. Share this episode, please, and I can't wait to see you again soon. Hey, it's Mel, and I want to thank you for your time and attention today watching this remarkable episode with Dr. Robynne. And if you enjoyed this episode, I have the perfect thing for you to watch next, because I think you remember there was that moment where she talked about the gut mental health connection. Well, how about we dig into that? I did an episode with Harvard's, Dr. Chris Palmer about the gut brain connection that will blow your mind. He is using nutrition to help people with mental health issues. It is amazing. And you can click that video right here. I know you're going to love it.