DavidPerlmutterMD · 2026-04-14 · David Perlmutter (host), Trisha Pasricha
You’ve Been Pooping All Wrong (And It’s Affecting Your Brain) | Dr. Trischa Pasricha
35 research-tied claims examined: 3 contradicted 3 overstated 5 context 19 supported 5 unverified
3 Contradicted by research
Chronic use of NSAIDs or H2-blocking acid reducers is associated with a dramatic increased risk of dementia and stroke.
"when we look at data recognizing a dramatic increased risk of dementia and stroke in individuals who chronically take either NSAIDs or these H2-blocking drugs, we have to pay attention to what's going on in the gut." (said at 0:40:20)
The assertion that chronic use of NSAIDs or H2-receptor antagonists (H2 blockers) is associated with a dramatic increase in the risk of dementia and stroke is contradicted by systematic reviews and meta-analyses. For dementia, meta-analyses of randomized trials and observational studies show no significant association between NSAID use and the development or progression of Alzheimer's disease (PMID: 39690983), nor any significant association between H2 blocker use and dementia risk (PMID: 34811582, pooled HR 1.20, 95% CI 0.98–1.47). For stroke, while some NSAIDs (particularly certain COX-2 inhibitors or specific non-selective agents) are associated with modest elevations in cardiovascular and stroke risk (e.g., hemorrhagic stroke RR ~1.33; PMID: 30153662), these effect sizes are modest rather than dramatic, and no broad dramatic stroke risk is recognized for H2 blockers.
- partial: Risk of Hemorrhagic Stroke in Patients Exposed to Nonsteroidal Anti-Inflammatory Drugs: A … (Neuroepidemiology 2018) · cited 20x in the literature
"The overall pooled RR of hemorrhagic stroke was 1.332 (95% CI 1.105-1.605, p = 0.003) for the random effect model." (abstract, results, passage verified)
pubmedfull study (doi) - contradicts: No association between acid suppressant use and risk of dementia: an updated meta-analysis… (European journal of clinical pharmacology 2022) · cited 12x in the literature
"Similarly, H2RA use was not associated with the risk of dementia, as indicated by the pooled HR of 1.20 (95% CI: 0.98-1.47). Results of this meta-analysis suggest that PPI and H2RA do not increase the risk of dementia." (abstract, results and conclusions, passage verified)
pubmedfull study (doi) - contradicts: Role of Nonsteroidal Anti-Inflammatory Drugs as a Protective Factor in Alzheimer's Disease… (Neurology India 2024) · cited 8x in the literature
"For Hazard Ratio (HR), the pooled HR calculated using the random effect model was 1.20 (95% CI: 0.95, 1.51), which was not statistically significant (P value = 0.15). Present meta-analysis shows that NSAIDs, in general, are not effective in the treatment of AD. They also have no protective effect against the development of AD on their sustained use." (abstract, results and conclusions, passage verified)
pubmedfull study (doi)
Short-chain fatty acids like butyrate improve the body's capacity to sense and respond to stool in the rectum.
"So I think that the beneficial short-chain fatty acids like butyrate have been studied as improving in some ways the capacity—there's two different aspects to this, but improving our capacity to sense and respond to stool that's sitting there in the rectum." (said at 1:01:02)
Human and animal studies do not support the claim that butyrate improves physiological rectal sensation or response to stool. In a double-blind, placebo-controlled crossover trial in healthy human volunteers (PMID: 19460106), rectal administration of butyrate dose-dependently decreased visceral perception, significantly reducing urge, pain, and discomfort during rectal balloon distension. In rodent models (PMID: 15940632, PMID: 22833396), rectal instillation of butyrate is widely used to induce pathological visceral hypersensitivity mimicking irritable bowel syndrome, rather than enhancing normal rectal sensory-motor reflexes.
- context: Rectal instillation of butyrate provides a novel clinically relevant model of noninflammat… (Gastroenterology 2005) · cited 171x in the literature
"Butyrate enemas induced a sustained, concentration-dependent colonic hypersensitivity and, to a lesser extent, a referred cutaneous mechanical hyperalgesia, particularly in female rats, but no macroscopic and histologic modifications of the colonic mucosa, as observed in patients with IBS." (abstract, results, passage verified)
pubmedfull study (doi) - contradicts: The effects of butyrate enemas on visceral perception in healthy volunteers. (Neurogastroenterology and motility 2009) · cited 170x in the literature
"Butyrate treatment resulted in a dose-dependent reduction of pain, urge and discomfort throughout the entire pressure range of the protocol... Colonic administration of butyrate, at physiologically relevant concentrations, dose-dependently decreases visceral sensitivity in healthy volunteers." (abstract, results and conclusions)
pubmedfull study (doi)
Short-chain fatty acids have anti-inflammatory effects and do not sensitize visceral pain nerves.
"There's a different type of sensitivity that we sometimes talk about which is not what we think happens with short-chain fatty acids like butyrate or others, which is that if the nerve cells that sense pain and send pain signals up to the brain become more sensitized, that would be a bit of a problem. But we actually think that the short-chain fatty acids have anti-inflammatory effects and don't do that." (said at 1:01:36)
While short-chain fatty acids (SCFAs) such as butyrate possess established anti-inflammatory and epithelial barrier-supporting properties, preclinical research contradicts the assertion that they do not sensitize visceral pain nerves. Experimental models of irritable bowel syndrome demonstrate that butyrate can directly promote visceral hypersensitivity by inducing mast cell degranulation and sensitizing dorsal root ganglion (DRG) nociceptive neurons through upregulation of TRPV1 and protein kinase C pathways.
Unverified means no publication matching the claim was located; it does not prove the claim false. Spotted an error? See the corrections policy - disputes from the people quoted are prioritized.