The symptom I was too embarrassed to write about

Hey Reader,

Well, you voted. And let me tell you, it wasn't close.

When I asked what you wanted more of in this newsletter, I honestly figured the answers would be scattered all over the place. Some of you would want interviews. Some would want recipes and tips. Maybe a few kind souls would check the box about my recovery just to make me feel good about myself.

Nope.

Overwhelmingly, you told me you want to hear about the medical mystery. The three-plus years of it. The tests, the dead ends, the doctors, the diagnoses that weren't, the surgery, and everything that has come since.

I sat with that for a few days because, if I'm being honest, it surprised me. I've spent a long time worrying that this story is too much. Too heavy. Too weird. Too... me.

But you asked. So, here we go.

And we're going to start in the least dignified place possible...

What's Inside

The poll result
The symptom I never wanted to write about
Dr. B's rules for getting things moving
The slingshot (this one explains a lot)
My health today
Dr. B's amazing new course
Book of the Month: Dr. Michael Greger's "How Not To Hurt"
Come see me on the road (or stay home)

The Symptom I Never Wanted To Talk About

I've written to you about the bloating. The belching. The brain fog. The weight that came on out of nowhere while I was eating about as clean as a human being can eat.

What I've mostly skipped over is the constipation.

Not because it wasn't a big deal. Because it was maybe the biggest deal of all. And because writing the word "constipation" in a newsletter feels roughly as comfortable as showing up to a wedding in swim trunks.

But here's the truth of those years: I was going once every four days. Sometimes worse. Everything I ate felt like it hit a wall and just stopped. And when things finally did move, it wasn't a triumph. It was a catastrophe. Days of nothing, and then everything at once, and none of it well formed.

For years, I could not figure out how that was even possible. If it had been sitting in there that long, shouldn't it come out hard? How on earth do you go four days without going and then end up with the opposite problem?

So I finally asked the one guy on the planet I trust with that question.

My Friend, "The Duke of Dung"

Dr. Will Bulsiewicz came back on The Exam Room this month, and we spent the better part of an hour on the topic nobody wants to bring up at dinner.

The man has earned a lot of nicknames on this show. Duke of Dung. Pharaoh of Fiber. The guy who's number one at going number two. By the end of this one, I had to add a new title: Baron of the Bidet. (His actual first tip of the episode, before we discussed a single thing about diet, was that everybody on earth should own a bidet. He was not joking.)

Here's what stuck with me most.

FIRST, MORE OF US ARE IN THIS BOAT THAN ANYONE ADMITS.

The official statistic is that around 10% of people are dealing with constipation. Dr. B thinks the real number is closer to 25%, because the official definition leaves out an enormous group of people who technically go every day but still feel awful. Bloated. Never quite empty. Out of rhythm.

His definition is much simpler, and I love it: if you aren't sufficiently emptying your bowels and you're suffering symptoms because of it, that's constipation. It doesn't matter whether you check the boxes on some chart. If it's wrecking your quality of life, it's a problem worth fixing.

SECOND, THERE ISN'T JUST ONE KIND.

This was the part that reframed everything for me. Dr. B boils it down to two questions:

Are things moving through at the pace they should?

And is your bottom actually letting things out when the time comes?

Those are two completely different problems. About one in three people with constipation don't have a sluggish gut at all. Their pelvic floor simply won't relax, so everything gets held up right at the exit. And here's the kicker: the single most common type isn't slow transit at all. It's normal transit. The plumbing works. The rhythm is just gone.

Which explained something that had bugged me for years. Way back in the barrage of testing I went through, they measured my transit time and it came back fine. I remember thinking, well then what in the world is wrong with me? Turns out you can have a stomach that empties quickly and a system that's still completely out of sync further down the line. Dr. B called it a New York City subway system where some trains are early and some are hopelessly late. Same tunnel. Guaranteed wreck.

I told him millions of New Yorkers call that Tuesday.

The Slingshot

Okay, this is the part I want you to hear if you hear nothing else.

I asked him how you can go days without going and then have everything arrive as a liquid emergency. He said to picture a slingshot.

Day one, no poop. You've pulled the band back a little. Day two, nothing. You've pulled it back further. By day three, that thing is loaded and the colon says enough, revs up, and fires. The stuff that has been sitting the longest comes out hard, and everything stacked up behind it hasn't spent enough time in the colon to have the water pulled out yet. So it arrives soft, then loose, then urgent.

That's not diarrhea. That's constipation wearing a disguise.

And he made a point that made me a little angry on behalf of everyone this has happened to: if you walk into a doctor's office and complain about the "diarrhea days," there's a decent chance you'll be told to take an anti-diarrhea medicine. Which is exactly backwards. You have to zoom out and see the pattern.

The fix isn't to treat the explosion. It's to never load the slingshot in the first place.

Building The Rhythm

So how do you do that? A big chunk of the answer is something I would have rolled my eyes at a few years ago: routine.

Your gut runs on a circadian rhythm just like the rest of you. There's a reason mornings are prime time. Your body wakes up, your intestines get a fresh wave of movement, and that's the window.

Dr. B's morning playbook is not complicated:

Get outside and get some morning sunlight
Hydrate. Real water, a good amount of it
Coffee if you drink it
Eat breakfast
Go sit down 🚽

Even if you don't feel a thing. Sit for five minutes. Don't strain, don't push, don't force anything, and don't stay longer than five. If something happens, wonderful. If not, get up and walk out.

Do that a few days in a row and your body starts to learn what you're asking of it. That's not folk wisdom. You can genuinely train the timing of a bowel movement. I still think that's one of the wildest things I've learned on this show.

You can watch the full episode by clicking image below.

More To Consider

If your stool is hard, that's where you start. Soften it first, then worry about everything else.

Food can absolutely do heavy lifting for mild cases. Two green kiwis a day have held up in human trials. Prunes and prune juice. Well-hydrated chia. Psyllium. Really, fruit in general.

But he was refreshingly blunt: mild cases are not the ones showing up in a gastroenterologist's office. If yours is moderate or severe, diet alone probably isn't going to get you there, and there's no shame in that.

On magnesium, the type matters enormously. Glycinate and threonate do essentially nothing for constipation. The ones that work are oxide, citrate, and sulfate. He prefers oxide because it's absorbed the least and has the most human trial evidence behind it. (Check with your own doctor first, always.)

On stimulant laxatives, senna and the rest of that family, he's cautious. He dug hard into whether they're truly habit forming while building his new course, and his honest answer is that the evidence isn't overwhelming in either direction. But between what he's seen in his own clinic and what's in the research, he'd rather not go that route.

And there's a test I'd never heard of in all these years called the blue poo test, out of a study published back in 2021. You eat something dyed blue, then watch for when it shows up. Longer than about 58 hours from mouth to bottom and you're looking at slow transit. It's not a diagnosis, but it's real data about your own body, which is more than most of us have.

My Health Today

Here's the part I didn't expect to be writing.

Gone are the days of going three and four days without going. Gone are the days of everything arriving at once. Instead there's a nice, ordinary ten-minute get-to-know-yourself session every morning. Clear the head, clear the colon, feel good about life.

I got there by doing the boring stuff. I spent a few days with Dr. B when he was in DC last month, watched how he actually lives this, and just started following the playbook. The supplement in the morning, then out the door for a walk and some sunlight, then breakfast. Within a few days the ship started to right itself.

As I write this, I'm far from perfect, but trending in a much better direction. After three years of chaos this feels like winning a championship.

And there was a bonus I never saw coming. My appetite is coming back. I can eat a bigger portion now without feeling like I'm going to burst. When I mentioned it to Dr. B, he wasn't surprised at all. When the colon is full, the stomach can sense it and slows way down. That gives you nausea, early fullness, no appetite. Get things moving again and the whole system wakes back up.

Three years I spent wondering why I couldn't eat a normal amount of food. Part of the answer was sitting at the other end the whole time.

If You're Struggling Too

I've become a huge fan of something else Dr. B has created. His 38Tera supplements have played a huge role in my recovery as well.

The DMN and RCE are teaming up in my gut to reestablish rhythm and consistancy after all this time! And it didn't take long for them to get to work!

Even on my "off days" I know that there won't be any more three or four-day long constipation streaks. Since I've been using them the longest I've gone without going is two days. And even that is stretching it now!

If constipation is running your life the way it ran mine, I HIGHLY recommend them.

TRY 38TERA

I have to tell you about something that happened at the International Conference on Nutrition in Medicine in DC.

I got to sit down with Dr. Michael Greger for his very first conversation about his new book, How Not to Hurt. First one anywhere. And if you've ever watched Dr. Greger get going on a subject he's been buried in for years, you know exactly the kind of hour that was.

The subject this time is pain.

What Dr. Greger has done is comb through the randomized controlled trials looking for the interventions that actually hold up. Non-invasive. Non-pharmacologic. And in a lot of cases, ignored precisely because nobody stands to make much money off of them.

He digs into osteoarthritis, back pain, migraines, and fibromyalgia. He explains why some of the over-the-counter drugs we reach for without thinking may actually be feeding the problem over the long haul. And he lays out what he calls the Soothing Seven, the whole foods with the strongest evidence behind them for fighting pain.

I don't have to tell you why this one hit close to home for me. Three years of hurting and searching for answers will make you pay very close attention to a book like this.

It's available for pre-order now.

Get "How Not To Hurt"

Come See Me

My friends at Mavy Wellness never gave up on me when I was at my lowest.

Plant Powered Party
Las Vegas, Nevada
September 4–6, 2026

Healthy living meets Las Vegas. What could possibly go wrong? Actually, this is going to be fantastic. Great speakers, great food, great people, and a whole lot of plant-powered energy.

Get tickets and see the speakers here

Mavy Wellness Retreat
Las Vegas, Nevada
September 8–10, 2026

Right after Plant Powered Party, I'll be joining Maxime Sigouin and the Mavy Wellness crew for a few days focused on fitness, nutrition, strength, and building the kind of healthy life that lasts.

Get tickets and see the speakers here

Wellness Weekend West Virginia
Canaan Valley Resort
Davis, West Virginia
October 9–10, 2026

I'll also be heading to beautiful Canaan Valley Resort for Wellness Weekend West Virginia. This one has such a special feel to it, and I'm really looking forward to being there.

Get tickets and see the speakers here