Gut Health: What You Need to Know

Welcome, everyone. I'm Dr. John Whyte, the chief medical officer at WebMD. We all know the importance of the heart. We know the importance of the brain. But how important is the gut? We know it functions for digestion.

What if I told you it also plays a role in our mood, in our immune function? My guest today has a new book out. It's called Gut, an Owner's Guide. Please welcome Dr. Austin Chang.

Hi, John. Thanks for having me on.

Well, it's great to see you, Austin. And I know you're a gastroenterologist, but still, I have to ask, why did you write this book?

AUSTIN CHIANG: Well, I felt like-- here's the book, first of all.

Here it is. I have my copy.

Thank you so much. Yes, so I felt that there was a need for an illustrated, colorful, and fun resource for the everyday person to learn about their gut health and understand the complexities of the system because, to your point, it's not just a transport tube for food, but there are so many other functions and other organs as well involved, including the liver, the pancreas, and a lot about care around the gut that people encounter when they go to the hospital or to the office that can be a little confusing.

And so, you know, not only does it talk about the certain gut health conditions, but also the procedures that are involved and the innovation around that. Also a lot of myths that we try to debunk in this book as well because, as somebody who is a heavy social media user, there's a ton of misinformation online that could be clarified.

And we're going to go over some of them, but I want to get at the fact, because we didn't always think about the microbiome 10 years ago. Now, you know, we all talk about it, but there's also the two-way communication system of the gut, rest of the body with the brain. Some people even call it the second brain. What's your thoughts on that?

Yeah, the second brain has been something that we've referred to the gut in a lot of ways because it has its own nervous system. It's able to move on its own and function on its own. But this linkage between the gut and the mind, that's something that is, you know, relatively new and it's bidirectional. So not only does the gut affect the brain, but the brain can also affect the gut in certain ways.

And this is an emerging area. There's still a lot we don't understand. It's a lot of mystery as of yet, but there's emerging research about how, you know, potentially stress and emotion can actually lead to some changes in the gut, like inflammation and potentially worsen some gut health conditions. So it's a very exciting area. There's still a lot we don't know. And I'm very transparent in the book about keeping things evidence based and, you know, making it clear that there's a lot that's yet to be discovered in this space.

You have a great way of communicating some complicated biologic issues. And one of my favorite sections of the book, Austin, is the poop rainbow, because let's be honest, you and I are both internal medicine physicians. You're specialized in gastroenterology. I get a lot of questions about-- a lot of questions about poop from my kids as well. But tell us about this poop rainbow.

I really appreciate you bringing it up because that's actually the whole reason why this book was brought about. Why the publisher approached me was because there's a video that I made on YouTube called "The Poop Rainbow," and they kind of wanted me to adapt my social media voice into text format into something that's easily accessible and digestible, pun intended, for the everyday reader.

And so the poop rainbow is basically talking about if you were to look at your poop and, you know, depending on what color you're seeing, could it be something, you know, more serious. And this ranges from, you know, poop being red colored, black colored, green, gray. There's a lot of variation in poop color based on what we eat, but there's a lot of, you know, conditions that potentially can lead to these changes in poop color as well.

How often should people poop a day? That's a question I always get asked. And if they haven't pooped in a day or so, they're worried. But we have definitions of average number of times people should poop for a week even.

Yeah, this is super variable. It varies from person to person. Even for an individual, there's some variation there too. Generally speaking, we say, you know, if it's any more than three times a day, then that's unusual. But, you know, it really depends on the person.

For some people, we see people pooping several times a day. For others, we see them pooping only a few times a week. And it's all about determining whether or not there's any sudden changes to your usual routine because that's when the alarm bells should go off.

But in general, everyone doesn't have to poop every day. Is that right in terms of some myths?

Yeah.

We're going to get to more myths.

Yeah, absolutely. There's no hard and fast rule that you have to go every day or that you have to make yourself go every day. It's really dependent on what you eat, what the circumstances are in your life at the moment--

And activity level. You have to move-- to move your bowels, you have to move, you know, in person.

Absolutely.

JOHN WHYTE: The other big question people ask, and I know you'd be good to talk about this because you're very good on social, people always want to know about gas. I'm being elegant in my terminology. You use other terms in the book, but what should people know about gas?

Gas is very normal, but there's a lot of reasons why people can have air or gas in your gut. You know, some of it, not all of it is actually a result of food in the bacteria in your colon fermenting that and creating gas. Some of it is actually gas that we inadvertently swallow while we're talking while we're eating. And so the reasons why some of us might feel bloated more than others, you know, it could really vary depending on what source of the gas it might be.

Tell us one or two myths that you address in the book that really are quite common, that you hear fairly often?

So two common myths that circulate a lot on social media. One is leaky gut syndrome. I clarify in the book how intestinal permeability, that concept of, you know, the gut being permeable is true, but leaky gut as a diagnosis isn't well established.

So in certain conditions, you know, like inflammatory bowel disease, it is more pronounced that your gut becomes a little bit more permeable. And things may-- you know, that barrier in the gut isn't as intact. And so things can make their way through the gut wall a little more easily.

But that's-- so that's one myth. And the other one is about colonics is something that we hear about a lot. People are getting colon cleanses, getting water infused throughout their colon. And for various reasons, some people just want to feel better. Some people feel like it's helping them lose weight.

But we don't recommend that as a field because often the people administering these colonics are not-- you know, they're not able to see inside. There's a risk of actually puncturing the bowel wall. So it's actually potentially dangerous.

And not only that, but when you infuse a large volume of water, there may also be electrolyte shifts that could be dangerous, especially for some people with underlying conditions like kidney issues or other reasons why you might already have electrolyte imbalances. So you've got to be very careful about that. And really, there's no reason why anyone should get a colonic to rinse their colon out because your colon is naturally already excreting all that waste.

It's always a good reminder, whenever we talk about the gut to remind people about screening for colon cancer. And sometimes there's confusion about what the recommendations are or what does average risk mean. Can you remind our audience what's the latest recommendations as it relates to getting screened for colon cancer?

Definitely. So everyone out there in the population needs to get screened for colon cancer. If your average risk, meaning you don't have any underlying conditions or any family history of colorectal cancer or any underlying conditions that predispose you to colorectal cancer, everybody has to start getting screened at age 45.

And the preferred method, the gold standard, is colonoscopy, which is where we place a camera through the entire colon to actually take a look directly. And we're able to locate where there might be any precancerous growths and remove them on the spot. There are other noninvasive stool tests, and I know there are blood tests also being developed currently, but those will allow you to locate where the problem is and address it on the spot.

You have a great section in the book about the kitchen, how to make sure that you don't get foodborne illnesses. Lot of great tips. What do you want people to take away from this great new book, Gut, an Owner's Guide?

AUSTIN CHIANG: From that standpoint, I just think that everyone should have a heightened sense of awareness and, you know, sometimes pay attention to the labeling on their foods. Some things are labeled organic or natural. There's a lot of these marketing terms thrown around, and they may not actually mean any true health benefit.

And generally speaking, I mean, my goal with this book is really just to start a conversation. I think we need to destigmatize gut health, be comfortable with talking about it more. I think for a very long time, people felt uncomfortable talking about gut health because it's about butts and guts.

And I understand that there's a time and place for these sorts of conversations. And not everyone wants to talk about poop at the dinner table, but getting more comfortable with just even talking about it in general. And the more we talk about it, the more there's a conversation and awareness around it, the more we can prevent people from getting serious conditions.

JOHN WHYTE: And the understanding that you help us of the microbiome, the impact on immune function, the impact on our mood, the second brain, really the power of the gut that we may not all realize. Tell our viewers how they can learn more about you and what they're doing if they don't already.

Well, thank you. I'm pretty easy to find on the internet. My handles are the same everywhere. AustinChiangMD on Instagram, TikTok, YouTube, X, you name it. I'm pretty much on every single platform. And, you know, I love being on social media educating people. That's really my main purpose on there is to be an accurate voice because there's so much misinformation out there.

Well, you've done a terrific job. Bravo! Dr. Austin Chiang, thanks for joining me today.

Thanks for having me.