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Episode 51: Are Hand Sanitizers Slowly Killing You? [Straight From The Gut]

Episode 51: Are Hand Sanitizers Slowly Killing You?

Since the beginning of COVID, we’ve been asking an important question: how does the widespread use of hand sanitizers and heavy-duty, antimicrobial cleansers impact our individual and collective microbiomes? 

On this episode, science has an answer for us. Andrea is joined by Afif Ghannoum for another “Straight From The Gut” episode where the two riff on the latest research and news surrounding the microbiome. 

Along with dissecting what common household chemicals and agricultural products like Roundup are doing to our microbes, they also delve into a new, large-scale study that analyzed the guts of kids who were given antibiotics before the age of two. Can you guess what happened later in life? 

As with all SFTG episodes, this one is so much more than the few studies mentioned, as both Andrea and Afif dig a few interesting rabbit holes and expand the discussion beyond just the world of microbes. 

Questions? Ideas? Email us at or reach out on Instagram @DreEats or @BIOHMHealth

Approximate Timestamps: 

  • Effect of common household chemicals on the microbiome (4:00) 
  • How Roundup and glyphosate are banned in many countries around the world, but not in the US (6:18) 
  • When we kill 99.99% of germs – what is left? (7:36) 
  • Plant-based meats (11:34) 
  • Voting with your dollars (15:00) 
  • Antibiotic use in babies (15:56) 
  • Some questions to ask when shopping the farmer’s market (19:18) 
  • Grocery store stock - what has to give? (22:17) 
  • Fructose vs. fruit and the microbiome (27:17) 
  • Proper pooping position (30:41)

Mentioned On This Show:

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BIOHM gut quiz


Andrea Wien: Welcome, welcome to the Microbiome report. I am your host, Andrea Wien. And today we have another straight from the gut episode with BIOHM CEO, Afif Ghannoum. This is a really good episode. If you are at all concerned about the impact of what COVID is doing in terms of the chemicals that we're using on our surfaces, on our hands, on literally everything that is being touched in our world today, it's something that I've been concerned about since the beginning of COVID when hand sanitizers and cleaners and everything have just been used so ubiquitously. So we have some studies that we talk about the impact of that on the human gut microbiome, and also the impact of certain chemicals, herbicides, fungicides, glyphosate that you may have seen in the news. So we're starting to get some interesting data back on those things. And will talk about that in this episode. We also talk about antibiotics in kids under two years old and the impact that it can have on problems later in life.

So that's a really important one if you have kids or if you took a lot of antibiotics in your youth, it's something that might tie some pieces together. We also go down a couple of different rabbit holes, talk about sugar and the differences in high-fructose or fructose corn syrup and actual fruit. So really interesting just in how the body processes that, but this episode, like all of these episodes goes into a lot of different conversations that we had a lot of fun talking about and I really think that you will enjoy. Let's get to the show. Afif, hey. How's it going?

Afif Ghannoum: It's good. How are you?

Andrea Wien: Good. December, it's our last one. 2020 is almost over.

Afif Ghannoum: It's going to end with a bang because last Tuesday we got 22 inches of snow in one day. So that's [inaudible 00:01:54].

Andrea Wien: Yeah, we're recording this a little late because you are out of power and we were buried under snow and hopefully that's not a sign of a terrible winter to come.

Afif Ghannoum: Yeah, hopefully.

Andrea Wien: So we have some interesting stuff to talk about today. And this first one is something that I have been talking about since COVID became a thing. And people started using copious amounts of Lysol and rubbing alcohols and all of these chemicals to kill everything. And my concern has been, and I think we've talked about it on this, that we're going to see some long-term impacts of that on microbiome health. Because when you kill everything around you, except for the 0.1%, right? These things kill 99.9% of things. That 0.1% is the really awful virulent, terrible stuff and now suddenly it's left unchecked, right?

So we now have some research that's coming out around us and researchers have found a connection between household chemicals and the microbiome and specifically they were looking at children. So even more terrifying, right? No one wants to be messing with the microbiomes of children with chemicals that could potentially be really dangerous. And what they found is that the microbes that were in the guts of children are totally different if they've been exposed to a lot of different household chemicals. And these are things just to give people an idea, detergents, plastic clothing, such as raincoats, shower curtains, personal care products, like soap, shampoo, hairspray, stain and water repellents for fabrics, coding and fabrics.

Afif Ghannoum: So everything?

Andrea Wien: Literally everything. Yeah. And I think people are starting or we're starting to really begin to think about what they were using in their home and we have things like the hygiene hypothesis and people were saying, okay, maybe bacteria and all this stuff isn't so bad to have around and maybe I should start cleaning with some less toxic stuff and then COVID hit and we are where we are.

Afif Ghannoum: Can I add something though, because I think this is something that most people don't realize, right? So we obviously have a ton of awareness right now about FDA's role in approving drugs and we need to make sure it's safe and all this stuff, right? Because of COVID, we're hearing a lot about it. I don't think people realize that why drugs have to be approved, new ingredients that go into foods and any type of drugs supplements. They either have to be approved or they have to be shown to be something called [inaudible 00:04:34], which is generally regarded as safe. Okay. So for example, we have to show to grass documentation and it's very thorough, right? Why? Because generally we got it. Everybody wants to make sure what we're putting in our bodies is safe. What people don't realize is chemicals that go in plastics, any of these things you just talked about, they don't need to be pre-approved. Companies can just start using a chemical and it basically has to be proven, basically-

Andrea Wien: It's innocent till proven guilty, yeah.

Afif Ghannoum: Literally. Right. And this is stuff that you hear about it getting in rivers and cows drinking it and they're foaming at the mouth, they're crazy stuff. And it's all lobbying. Just do a quick Google search, you'll find a million articles about this, but I think people are blown away thinking like, "Wait a second, what's in my dietary supplements has been pretty heavily vetted over decades and decades very aggressively, right? But what's my plastic bottles are made of can be literally carcinogenic. And when you start talking like this, people think you're being like, well, but isn't this stuff safe? We'll use it. We wouldn't have it if it wasn't safe, that is not the case. So I think that's a really important point that people do not know not a lot of these chemicals. Basically all of these chemicals do not need pre-approvals before they're used in products. It's really insane if you think about it.

Andrea Wien: So only over time, as you're saying, when people start to have these reactions, do we say, "Oh, wait a minute." And you saw this, you're starting to see this with glyphosate, which is actually our next topic that we'll get into in a minute. But this is more commonly called Roundup and it's the most widely used herbicide among farmers and even people who are homeowners, right? Like my parents used to just spray Roundup around the house for weed control. And now we're starting to say like, "Wait a minute, there's a lot of issues with this." Microbiome being one of them.

Afif Ghannoum: Well, in a lot of these products, and I know this isn't quite microbiome centric, but I think this is important for people to honestly realize is a lot of these ingredients, a lot of these products, they're actually illegal in other major developed countries. If you look in Europe, I'm 99% sure, Roundup is literally illegal, right?

Andrea Wien: Yeah. That's a lot of these things and unfortunately, we won't get political here, but the current administration has reversed a lot of the regulations that the Obama administration put into place to ban some of these chemicals. Trump administration came in and said, "No, actually they're fine," when the science is very clearly telling us that they're not.

Afif Ghannoum: Unfortunately, it's coming down to, you have to be personally responsible for being aware of these things. And the sad thing is... Look, think of that list you rattled off. It is impossible to avoid this stuff now. You know what I mean? It's not just, "Oh yeah, I just need to eat organic. Oh, I just need to have like paper." You can't. You know what I mean? Everything we use is made of these things. So going back, bring it back to your point. You bring up a very good point about that. Like, "Oh, kills 99.9% of germs." What about that 0.1%? You're talking about stuff that's seriously resistant to drugs to cleaners. These are vicious organisms. So it's really an interesting study.

Andrea Wien: Yeah. And I mean, in the study, the thing that I think the most interesting is that the children, obviously you would have assumed that they would have a reduction in the amount and diversity of bacteria because these things are killing those, but they also found that these kids had bacteria that have over time learned how to break down these chemicals. So they're actually have bacteria in their gut. They're not typically found in the human gut. This is not something that you usually see, but because these kids have these chemicals in their system, their bodies have brought in these bacteria that are breaking down the chemicals. So it's actually the microbiome like trying to correct itself. Which obviously you don't want the microbiome to having to be working to do that, but it's interesting that the human body is able to respond in this way.

Afif Ghannoum: It is, but what's so concerning about that is we often talk about the fact that your microbiome can be in good shape unless you're immunocompromised, right? And I harp on this, but people think of immunocompromised as being severely ill, like cancer, HIV or maybe even you hear about immunity support products. [inaudible 00:09:04], "Oh, if I get cold and flu or something like COVID obviously hurt my immune system." But a lot of things can hurt your immune system, right? Like stress, your diet, processed foods, alcohol, the way you sleep. So my point is, if you're immunocompromised through some of these everyday factors we all live with and your microbiome becomes weak and it's trying to deal with these very aggressive types of organisms. That can be a big problem, right? Because then your system, if it's not up for fighting the fight, if all of a sudden those organisms, which are very smart, they start realizing how they have to mutate to protect themselves, right? That's where I think you're going to see these problems.

Andrea Wien: Absolutely, yeah. And I think the next question then becomes, and this study did not look at that, but we talk about the metabolites that are driving a lot of the processes in the body. So metabolites again, for people who might not have heard a past episode are the byproducts that the bacteria and these fungi in our microbiome are spitting out, which arguably now have been linked to more of the health outcomes. It's not actually the bacteria and the fungi, it's what they're producing. So these ones that are not native to the human gut and are breaking down these toxic chemicals, what are those metabolites? What are those byproducts? And how are those going to impact?

Afif Ghannoum: Yeah. Again, I always say this anytime there's something crazy in the world happening or it's, "Oh, this is never going to end." I would say, this period of time, from when we've had computers or even industrial society, it's a blink in the eye.

Andrea Wien: So to build on that, I mean, it's similar, but a little bit different. I mentioned glyphosate and there was another study that came out about how gut microbes, quite a lot of them are harmed by glyphosate. So we've been hearing a lot of news about Roundup glyphosate in the news this year, and now they're starting to really break down. Okay. It doesn't have an effect maybe on certain pathways of the human body, which is why historically had been thought of as safe. But this study has found that over 50% of gut microbes are harmed by glyphosate. So when we start to really dig into the whole body approach and not just look at one pathway that something works on, then we start to see issues and this is why some of these chemicals have gone under the radar for a long time, even though people who are working with them or exposed to them have been sounding the alarm bells for decades.

Afif Ghannoum: Well, can I ask you a question? Because you're one of the more informed people I know, especially on the nutrition side, what's your vibe about these plant-based meats that it seems they have a lot of, I always mispronounce it, glyphosate in them?

Andrea Wien: Yeah. So I'm not a fan of the plant-based meats. I think when you look at any ingredient list, right? You want the ingredients to be simple. I want to be able to find them at my local grocery store. And a lot of these meats are a lot of chemicals, a lot of binders, our body doesn't recognize that as food. So while yes, there's not meat involved in it and we can get into a whole discussion about regenerative farming and why that actually may be more sustainable option than some of these plant-based meats, they're not my top pick for people for the most part. And I think it goes back to when we looked at Cheetos and Doritos and Twinkies, when we talked about their fun, not food, our body feels the same way, even though you feel like you're doing something good, because you're like, "Oh, it's, plant-based," the marketing around them is phenomenal, right? But the human body has not evolved to a place where it understands all of the intricacies of soy protein isolates and different binding agents to recognize that as food.

So my thing is always, if you're going to eat meat or a meat like substance, find the one that is grown and raised the most sustainably helpful way possible. And then if you're concerned about consumption limit it, right? We should be limiting our meat consumption across the board, but these options just don't sit right with me.

Afif Ghannoum: I've also heard a lot of people who are in the know about nutrition be like, I actually really don't like these so I just want to see [inaudible 00:13:29] .

Andrea Wien: Yeah. And I think it's super concerning. The glyphosate issue too, it's not just problematic for the... We buy organic in my house 99% of the time, even the organic farmers are saying glyphosate is a problem for us because the farm two doors over is using it. Now it's in our groundwater. It's still showing up. So we're contaminating our environment and the soil health, right? These things like glyphosate, they are herbicides, they are insecticides, they are fungicides, they're there to kill pathogens, but we need the... It's the same thing as what's happening in the gut is happening in the soil. And so we need that good balance of microbiome in the soil. And if we're using all these things, we're not getting that. And so we're depleting the soil. We have less nutrients. If you start to really back up, you can get what we're talking about at a macro level, what some of the stuff environmentally that's happening and then we can get very micro with the individual person's human gut, but they're all the same.

Afif Ghannoum: So again, going back to my original comment about what's allowed in the US versus other countries, just look it up as we're talking. Even countries that we don't think of as developed have ban this, like Saudi Arabia, Vietnam, like Germany, obviously very developed country, but it's amazing how much of this stuff is really not allowed because it's past some safety muster it's lobbying. It's very bizarre.

Andrea Wien: Yeah. And I think people can feel very dejected by that, but the reality is look at what happened with organics. people vote with their dollars. So if you start buying more natural cleaning products, you start buying organic products, you start asking even the farmers at the farmer's market, what are you spraying on this? The more people that are asking those questions, that's how we change things. And you see it now. I mean, there's an organic section at Walmart and we could talk about the pros and cons of that.

Afif Ghannoum: I was literally going to mention that.

Andrea Wien: But the reality is, that was done by consumers. So if consumers are asking for things that are sprayed less, products that are safer for their families, that's what industry will make.

Afif Ghannoum: Very cool.

Andrea Wien: So, man, I feel like we're on a little bit of a depressive streak today. This next study is not good either, but I think it's important to talk about was one of the big ones that came out over the last few weeks. So we obviously talk a lot about antibiotic usage and using antibiotics in a very limited way. Obviously, they can be incredibly helpful and necessary and lifesaving, but there was a study that came out that antibiotic use in babies is linked to allergies, asthma, and a host of other conditions. So babies and toddlers who received just one dose of antibiotics before the age of two were more likely to have a whole host of issues and then multiple antibiotic treatments. These children were associated with having multiple conditions, the study found. So again, I think there's a time and place for antibiotics and certainly if you are someone who had antibiotics as a child or have given them to your child, there are ways to remedy that.

But if you can avoid them... Think back to when I had my son and we took him into the pediatrician and then he said, antibiotics was something that was very important for me. I wanted to go to a pediatrician that didn't just jump to antibiotics right away. And so we had that discussion very early on and I won't forget my pediatrician said, "The majority of the time we prescribe antibiotics for something like an ear infection, it's not for the kid, it's for the parent." He said, we don't actually have a great way to tell if an ear infection is bacterial or viral and we give antibiotics because it makes the parent feel better and so then your infection gets better regardless of whether it was bacteria or viral because that's just the course of an illness, but we don't really need to do that a lot of the time because a lot of these things are viral and they'll clear up on their own."

And I was just like, that's in my opinion, a huge downfall of where we're at in the medical community and what parents expectations are. And so studies like this, I think are really important to talk about because it's not without effect. If you're-

Afif Ghannoum: You made the comment on a depressive note. I agree with you, but I also think it's critical. Why? Because people don't... It's like my mother-in-law, she a few years ago got diagnosed with breast cancer and older woman, she's almost in her 70' and the doctor was giving her all her options and it was very early stage, right? But because he's giving her options, one of the options he said is, or you could choose to not treat it, right? I don't recommend that, but it is an option, right? And it really threw her off because she came from this generation where what the doctor said went right and they just trusted it, right? Now, listen. My father, most of his career has been around drug development. That's been life-changing in many ways, right?

This is not anti-medicine or anti-Western Western, the exact opposite. But you make the point that it's a very critical that you are asking questions and you're understanding exactly why various things are being prescribed or various treatments are being pursued, right? Because to your point, if you're suggesting this because you think it's going to put me at ease, you're not doing your job as a doctor. Right. I really believe that. So it's important that we're highlighting these things so people are informed to know what they should ask. Like you said, I go to the farmer's market and like most people, when I go, I feel like I've done my part for society, right? Like small business, all these things. It never even occurred to me to ask about fertilizers that you just said like, oh, you should ask the farmers. Yeah, you're right. I've never thought to do that. You know what I mean? So I think that's what these conversations should be doing is helping people to think like, what are the things I should be asking or at least aware of?

Andrea Wien: Yeah, absolutely. I mean, the majority of the farmers at the farmer's market are using some level of herbicides and pesticides. And so it's like, what are you comfortable with? And again, I've had these conversations where it goes a couple of different ways. The farmer either maybe gets defensive and says, well, it's impossible to grow X thing without that in this climate. And I said, that's great, thank you for letting me know. I just want to be aware of maybe how I should wash this differently or choose not to buy it or whatever that might be. And then on the other side they've said, well, we've never really had many people ask that and if it mattered more, we would change. So I think that that's where it becomes important.

Afif Ghannoum: So a book to this point that really I highly recommend it's called Grocery by Michael Ruhlman. Have you heard about this book?

Andrea Wien: I have not. No. [inaudible 00:20:36].

Afif Ghannoum: It's amazing book. So he's a big food writer and you'll get a kick out of this being also from Cleveland. So basically, his idea was, well, I don't know what all this stuff in the supermarket, how does it get here. How is it that I can buy tomatoes year round when they're not growing it. So he basically embedded himself in Heinen's, which is if you're outside the Cleveland area, it's like a, probably 20 store, very sort of well-thought of grocery chain. And so he worked at Heinen's for a year and he really followed the path of how do we get our food in the food supply. And one of the things they talked about, which again, I just hadn't really thought about is, this grocer really makes a point of they're very... They won't have certain vegetables and fruits at certain parts of the year because only it's very hard to get good products, right?

You're sourcing from places that the supply chain aren't clear or the reason they're able to make it grow at this time of year is because they're pumping it full of all sorts of bizarre, like you said, pesticides and GMOs and all those things. So it's a really quick read just to open up and realize that, where does our food actually come from? Because we're so disattached. So it's really interesting, but he talks a lot about that. Like, "Hey, why can't we get raspberries year round? They don't grow year round. So where are they coming from? How come we can get tomatoes that are bigger than baseballs now? Why is that?" You know what I mean? Things like that, that are just... And again, I'm in this industry and I don't know [inaudible 00:22:07] stuff, you know what I mean? So it's a really interesting read and it's not boring. It's a nice fun tone. It's definitely worth the roots.

Andrea Wien: Tandem book to read with that. And so if you read that one and then you're like, what do we do about it kind of thing? Or how do I shop better? I'm blanking on the name, but I'll put it in the show notes. I just finished this book to looks at a thousand different nutrients studies over the course of the last 10 years, I believe. And basically boiled it down to this book of how do you pick the best head of lettuce? How do you pick the best tomato? How do you cook it or use it different times of the years to bring out the best antioxidants and nutrients and those types of things. And which things you're saying, should you just stay away from at certain times of the year? So I'll put it in the show notes. Sorry, I can't remember it. And then the other thing we'll have a little quick quiz. And you might know this if it was in Michael's book, but people are always blown away. This is like one of my party trick jokes. What is the average age of an Apple at the grocery store?

Afif Ghannoum: A month? I have no idea.

Andrea Wien: 14 months.

Afif Ghannoum: What?

Andrea Wien: 14 months. So they're actually picking this stuff and maybe in season. They're picking it in season, but then they're holding it in these cold rooms with very dialed in specific gases that preserve it. So by the time it gets to you, it's on average 14 months old and really just like cellulose and water and sugar that's left in there. There's not a whole lot of nutrients. So stuff like that is just really mind blowing. And that goes back to our discussion on the farmer's market, buying local whenever you can is going to be the best way to preserve these nutrients that are already coming as we talked about from nutrient depleted soils. So when you start digging into this, like the rabbit holes go really deep. And I don't say this to be at all negative for people who are listening to this, like, Oh my God, where do I even start?

Afif Ghannoum: No, you just need to know, and then you can make decisions. Again, I read some article about Costco. I don't know if you remember, but they have rotisserie chickens for, I don't know $5, which is really amazing, right? Why do they do that? Well, they do it because they processed something like 200 million of these things a year. Wait a second. How do you process 200 million chickens in a way that's not just a mega plant, right? You don't, but that's the trade-off you got when you want a $5 chicken at Costco. I put their quality up there with anyone, it's a fantastic company, but there's just some things that are going to give. If you want a cook chicken for $5, do you know what I mean? Because you know they're already making money on that, right?

That's the part of, again, just raising your consciousness as a consumer is for you to get that, you're not going to have grass Fred or free range, anything it's impossible, right? So that's some of the things we're giving up when we're doing it to this. It sounds almost like conspiracy theorist, but it's really about opening up your eyes and understanding so you can make [inaudible 00:25:20]. And by the way, that doesn't mean it's a bad choice, it's just you got to realize-

Andrea Wien: It's just prioritization, right.

Afif Ghannoum: Exactly. Because there's an argument like, well, someone who's eating red meat all the time, maybe it is a good trade off that they're willing to do an impossible burger. Maybe it's not ideal [inaudible 00:00:25:42].

Andrea Wien: On the Costco note, I don't think that everything... So at Costco, if I'm correct, I read an article a while back, but they're the largest buyer of organic meats I want to say and pasteurized meats. So maybe not those artistry chickens you're talking about, but I lived in Australia for a while and one of our friends grew up on an 80,000 acre cattle ranch, which is just massive. It's takes like three and a half hours to drive across it. And we went out there and visited his family and we spent the night on the range and whatever, and all of the cattle were there, grass fed, free range, just roaming. And we were talking to the farmer and I said, "Where do you sell this? Where does it go?" And he said, "Costco, they're our biggest buyer." And so it's not that all of the meat at Costco.

I would have gladly eaten any of the meat that came off of that farm. It was gorgeous and they had access to fresh water and they weren't penned and all these different things. So you can make good choices and still have it be convenient. But again, to your point, there is a trade off, whether it's financial or something else. There's no free lunch, I guess this is the message.

Afif Ghannoum: No. And you know what? That's also why it's back to what you said. If the demand wasn't there, they wouldn't be doing that, right? If people were only asking for free range and organic, they would do that, but they wouldn't do the price. But for a lot of people, it's like we always talk about personalized nutrition. There's a trade off when you buy those things.

Andrea Wien: Yeah, exactly. So there was a study that came back that fructose corn syrup. So many people might hear of high fructose corn syrup can disrupt the microbiome, but fruit can actually undo the negative effects. And I think this is interesting because fruit is high fructose. So these researchers gave people in the study, it looks like a different high fructose diets. One was a fruit diet, a 100 grams a day of fructose from fruit and vegetables. And then after a low fructose phase, they gave them a high fructose syrup diet. So these came from just syrups that had been extracted. So if you think about it from a scientific standpoint, you're like, it's the same thing, right? Like there's fructose in fruit and there's fructose in this syrup. And yet there were completely different results. So they concluded that the fructose syrup caused a reduction of beneficial butyrate producing bacteria.

So again, talking about those metabolites and what they spit out and the gut microbiota profile shifted more towards high lipid profiles. So people were gaining weight, whereas high consumption of the fruits seemed to modulate the composition of the microbiome in a beneficial way and actually supported digestive health. So interesting that when we start to isolate things, and this is an argument we hear all the time from food manufacturers, like I'm just isolating an ingredient that's already natural. The body should respond in kind. And now we're seeing that, that's not the case.

Afif Ghannoum: Yeah. Again, it comes down to what you said earlier that a lot of these things are just in a format that your body is not... Maybe I'm thinking about it way too simplistically, but your body has to do some work to break down that sugar within an actual piece of fruit, versus if it's in a nutrition bar and it's like, you said an isolate, but it's readily there. Maybe it's just the way the body works and it's like, "Oh, I didn't even have to do anything here, it is." Right? So that's really interesting. I remember I saw there was a...

I can't remember the name of it, but there was a documentary on Netflix where it showed how your body works to process like 160 calories of almonds versus 160 calories of a piece of chocolate. And it was your body is going in overdrive. And it was really shocking to me because I've always kind of, oh, if you're managing calories, yeah, the only thing is great if you can do it, but that's key. And that's really not the case. It's like, your body is an engine that needs a certain type of fuel.

Andrea Wien: Yeah, absolutely. I mean, with this goes back to the discussion we had with Ben Goodwin on fiber. We did a whole episode and with Megan Telpner, we did a whole episode on fiber and that is such a critical piece of microbiome health. And so obviously, there's a lot of fiber in something like a Berry or an Apple or any type of fruit and there's not in any fructose syrups. This study also talked a lot about the different species and phyla of bacteria and things that they saw increases and decreases in. So if anyone has taken the biome gut health test and wants to cross reference with their results with this, I'm going to put it in the show notes so you can see the specific bacteria, it might be a fun exercise.

Afif Ghannoum: So can I hit you with one bonus topic related to the fiber thing?

Andrea Wien: Yeah.

Afif Ghannoum: Okay. I was talking to this physician and microbiome came up, "Oh, what do you do all this stuff? Right. And I could tell you, he goading me, like, "Okay, what do you think about dietary fiber? Right. So we were talking about it and he went through this whole thing about fiber being a little bit of a red herring and that it's not that people who deal with, especially regularity and digestive issues, constipation, that a lot of it is less to do with the fiber. And it's actually about the way we go to the bathroom. Right. And talking about the Squatty potty and adjusting your posture. You should play this video. He pulled up this video and it was a video Squatty potty had done, which I assume, you know what that is, right?

Andrea Wien: Yes, [crosstalk 00:31:36].

Afif Ghannoum: But we use it for basically the kid's stools, no pun intended, and he showed me this video and before Squatty potty got like tongue and cheek with their advertising. It was very science-y and it was showing like how your body adjusts and how the muscles move when you sit properly to go to the bathroom versus the way we sit on a regular toilet. And it was fascinating. I hadn't really heard much about that, but I don't know. Do you know anything about that?

Andrea Wien: Yeah. So I mean, a couple of things. So one, if you look for people who don't know what the Squatty potty is, it's basically just a little step stool that you put your feet on. So your knees are elevated above your hips and elongates your colon in a proper squatting position. And I think you can look- 

Afif Ghannoum: Because the theory being that until we have toilets. Again, like I said, things move in a blink of an eye. Before we had toilets that we sat on a hundred years ago, we basically would squat [inaudible 00:32:36] the bathroom. And that's how you're intended to go to bathroom.

Andrea Wien: Sure. And we still do it If you look at kids, right. I look at my son and when he goes to the bathroom, when he goes poop, he squats. He doesn't stand, he's not sitting, he squats to do it, right? And you look at some of the societies where their toilets are not as prevalent in Asia and India, these places. When you go visit, they're all just holes in the ground. Well, why is that? Because the proper position is squatting. So there's absolutely truth to that. And I have had a lot of clients have more success if they have issues with constipation, when they are using something like a Squatty potty. Now, if you don't want to go out and buy that, you can always... My husband does this. When we travel, I'll hear him wrestling around in the hotel bathroom, he'll take the wastebasket and just flip it sideways and put his feet on that.

So there's certainly ways around it. Put your feet on some books or whatever. The idea is just that your knees are higher than you're mimicking a squatting position.

Afif Ghannoum: So the real [inaudible 00:33:39] never touch the wastebasket in a hotel bathroom?

Andrea Wien: Yeah, exactly. All right. Well, thank you so much Afif as always, so much fun and yeah, we'll talk to you in the new year, hopefully 2021, where we're on the path to a different kind of year.

Afif Ghannoum: I know we got the 2021 [inaudible 00:34:02].

Andrea Wien: Fingers crossed. All right, guys. Well have great new year and we'll catch you in 2021.

Afif Ghannoum: See you.

Andrea Wien: As always, thank you so much for tuning in and listening to this episode of the microbiome report. We are now transcribing all of these episodes. So if you are interested in reading, instead of listening to any of these or going back and searching through the archives for anything you may have missed, all of our episodes are now archived over at That's also where the show notes for this episode will live. We'll link to all of the studies and any relevant information that we talked about in the show, such as those books will all be there. So thanks so much for tuning in. I am your host, Andrea Wien and have a great new year.

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