Why Does Coffee Make Me Poop?

Why Does Coffee Make Me Poop?

It’s not clear why coffee can stimulate a bowel movement, but the speed of this effect suggests it’s mediated by the brain.

By Alice Callahan  New York Times

Like opening the blinds and stepping into the shower, a cup of coffee gets people moving in the morning — in more ways than one. This satisfying brew revs energy levels with a dose of caffeine and, for many people, quickly and reliably jump-starts gut activity and an urgent need to poop.

But given coffee’s popularity, it’s surprising that we know so little about how it affects the gastrointestinal tract, said Dr. Robert Martindale, a professor of surgery and the medical director for hospital nutrition services at Oregon Health and Science University.

Some studies on the topic — which tend to be small, old and limited — have suggested that it’s probably not the caffeine that triggers the urge to go. One paper published in 1998, for instance, found that decaffeinated coffee had a similar stimulatory effect on the colon as caffeinated coffee, whereas a cup of hot water did not.

Coffee is a complex beverage containing more than 1,000 chemical compounds, many of which have antioxidant and anti-inflammatory properties. And determining how they affect the intestines is challenging.

One thing we do know is that coffee doesn’t affect everyone the same way. In one study published in 1990 in the journal Gut, 92 young adults filled out a questionnaire about how coffee affected their bowel habits; just 29 percent of the respondents said it “induced a desire to defecate,” and most of them — 63 percent — were female. (Though Dr. Martindale said that the percentage of people who have a bowel response after drinking coffee is likely much higher in the general population — he estimated that around 60 percent of his patients do — and he hasn’t noticed any differences between men and women.)

We also know that a gut response to coffee can happen fast. In the same study, some volunteers agreed to have a pressure-sensing probe inserted into their colon to measure intestinal muscle contractions before and after drinking a cup of Joe. Among those who said that coffee usually stimulated a bowel movement, the probe showed a significant increase in pressure within four minutes of drinking coffee, while the so-called nonresponses had no change in colon activity.

That drinking a cup of coffee can stimulate the opposite end of the gastrointestinal tract within minutes means “it’s probably going through the gut-brain axis,” Dr. Martindale said. That is, the arrival of coffee in the stomach sends a message to the brain, which then “stimulates the colon to say, ‘Well, we’d better empty out, because things are coming downstream,’” he explained. The coffee itself would move through the intestines much more slowly, likely taking at least an hour to traverse the long path from the stomach through the small intestine and to the colon.

This communication between the stomach, brain and colon, called the gastrocolic reflex, is a normal response to eating. But coffee seems to have an outsize effect; one study published in 1998 found that eight ounces of coffee stimulated colonic contractions similar to those induced by a 1,000-calorie meal. Researchers have hypothesized that coffee’s gut-brain messaging is likely caused by one or more of coffee’s many chemicals, and perhaps mediated by some of our own hormones that play important roles in the digestive process, like gastrin or cholecystokinin — both of which can spike after coffee drinking.

While the mechanism remains murky, coffee’s effects on the gut may be helpful for some people, including those recovering from certain types of surgery. Impaired bowel function is common after abdominal surgeries, for instance, which can lead to bloating, pain and an inability to pass gas or tolerate food. A 2020 analysis combined the results of seven clinical trials and found that drinking coffee allowed patients who had undergone colorectal or gynecological surgery to tolerate solid foods an average of 10 and 31 hours sooner, respectively. Coffee also reduced the time to their first bowel movement, by an average of 15 to 18 hours.

“A couple of sips of coffee can do it. It doesn’t take much,” said Dr. Martindale, who routinely offers his patients a cup of coffee the morning after surgery.

Dr. Martindale also suggests coffee, along with other dietary changes, when he counsels patients with chronic constipation. And he said it’s not uncommon for patients who have given up coffee for one reason or another to tell him, “Doc, I can’t go to the bathroom without a coffee.”

Sonya Angelone, a registered dietitian and spokeswoman for the Academy of Nutrition and Dietetics, cautioned against relying too much on coffee to stay regular. If someone is constipated, “it is not because they have a deficiency of coffee,” she said. Ms. Angelone recommends eating more fruits and vegetables, which are high in fiber, as well as increasing fluid intake and physical activity to address constipation. “What I find for a lot of people is they don’t start off with a fiber punch in the morning,” she said. Brewed coffee contains a small amount of fiber, about one gram per eight-ounce cup.

Some people find that coffee causes an upset stomach and loose stools, as well as side effects linked to excess caffeine, like insomnia, anxiousness, heart palpitations and headache, Ms. Angelone added. The Food and Drug Administration says that it’s safe for most people to drink 400 milligrams of caffeine — the amount in about four or five cups of coffee — per day. Though keep in mind that people metabolize caffeine differently, so this threshold can vary from person to person. “Coffee is one of those things, unlike other foods, that if it bothers you, you know it,” Ms. Angelone said.

But for the rest of us, coffee can be part of a comforting morning routine, waking us up in a multitude of ways.

I Have to Believe This Book Cured My Pain

A science writer investigates the 30-year-old claims of an iconoclastic doctor who said chronic pain was mostly mental.

By Juno DeMelo NY Times

Every time someone tells me their back’s been giving them trouble, I lower my voice before launching into my spiel: “I swear I’m not woo-woo, but … ”

Let me rewind a bit. For more than a decade, I had a near-constant throbbing in my left piriformis, a small muscle deep in the butt. I tried treating it with physical therapy, ultrasound and Botox injections. At one point, I even considered surgery to cut the muscle in half in order to decompress the sciatic nerve that runs underneath.

Then, in 2011, I picked up a library copy of the 1991 best seller “Healing Back Pain: The Mind-Body Connection.” It claimed that, in order to distract the sufferer from repressed anxiety, anger or feelings of inferiority, the brain creates pain in the neck, shoulders, back and butt by decreasing blood flow to the muscles and nerves.

The book’s author, Dr. John Sarno, was a rehabilitation physician at New York University and something of an evangelist, touting a methodology bolstered by anecdotes from his practice and passionate testimonials from patients like Howard Stern or Larry David, who described his recovery from back pain as “the closest thing that I’ve ever had in my life to a religious experience.”

According to Dr. Sarno, nearly all chronic pain is caused by repressed emotions. By undergoing psychotherapy or journaling about them, he said, you could drag them out of your unconscious — and cure yourself without drugs, surgery or special exercises. I chose journaling and began writing pages-long lists of everything I was angry, insecure or worried about.

I appreciated the tidy logic of Dr. Sarno’s theory: emotional pain causes physical pain. And I liked the reassurance it gave me that even though my pain didn’t stem from a wonky gait or my sleeping position, it was real. I didn’t like that no one in the medical community seemed to side with Dr. Sarno, or that he had no studies to back up his program.

But I couldn’t deny it worked for me. After exorcising a diary’s worth of negative feelings over four months, I was — in spite of my incredulousness — cured.

I didn’t think much about Dr. Sarno after that until May of this year, when I found myself back in physical therapy for a pain in my inner thigh. My physical therapist assigned me a handful of exercises, and I did them every day. The whole time, I worried: If physical therapy failed again, would I have to go back to exhaustively cataloging my woes? Did Dr. Sarno’s claims even hold water?

Pain often starts in the brain.

“The idea is now mainstream that a substantial proportion of people can be helped by rethinking the causes of their pain,” said Tor Wager, a neuroscience professor at Dartmouth College and the director of its Cognitive and Affective Neuroscience Lab. “But that’s different than the idea that your unresolved relationship with your mother is manifesting as pain.”

Dr. Wager said most scientists now believe that pain isn’t always something that starts in the body and is sensed by the brain; it can be a disease in and of itself.

Approximately 85 percent of back pain and 78 percent of headaches don’t have an identifiable trigger, yet few scientists would say that all or even most chronic pain is purely psychological. “There are also social and biological reasons for pain. In most people, it’s some confluence of the three,” said Daniel Clauw, a professor of anesthesiology, medicine and psychiatry at the University of Michigan and the director of its Chronic Pain & Fatigue Research Center. “I’m sorry, there are a bunch of people for whom Sarno’s method isn’t going to work.”

Today, a similar approach to Dr. Sarno’s method is emotional awareness and expression theory, in which patients identify and express emotions they’ve been avoiding. It’s not only been shown to significantly lower pain in people with fibromyalgia and chronic musculoskeletal pain, it’s also considered a best practice for treating chronic pain (along with massage and cognitive behavioral therapy) by the Department of Health and Human Services.

Pain can take on a life of its own.

But how does the brain cause chronic pain in the first place? Dr. Sarno’s theory that our brain uses pain to distract us from negative emotions by cutting off blood flow to the muscles is not backed up by science, according to Dr. Wager.

Instead of blood flow, scientists now look to the nervous system to understand chronic pain that isn’t caused by nerve or tissue damage. Basically, your brain circuitry malfunctions, prolonging, amplifying and possibly even creating pain.

Dr. Wager said we don’t fully understand the mechanisms of this, but “we do know that stressors can promote inflammation in the spinal cord and brain, which is linked to greater pain sensations.” Early adversity, such as child abuse, economic hardship, violence and neglect, has also been linked to chronic pain.

Six Tips for Treating Chronic Pain

1. Understand it. For those who experience it in chronic form, pain is its own disease, not just a symptom. Scientists now say it might be caused by specialized nerve cells going haywire.

2. Exercise helps. If you have chronic pain, you can still exercise. And, in many cases, it might just help you reduce feelings of discomfort and raise your pain threshold.

3. Control pain from the source. Although chronic pain is a disease, you have a great deal of power over it and can tap into your mind to start finding relief. One thing that may help? Keeping a diary to vent your feelings.

4. Reframe your thoughts. Experts are finding that pain psychologists can help you change how your brain processes pain.

5. Use helpful descriptive language. Using different metaphors or second languages to talk about your pain can actually change how much you feel it. For example, swearing outright may be more beneficial than using substitute words.

6. Find your team. In an ideal world, doctors would know how to deal with chronic conditions like pain. In this world, you might need to actively track down the care team for you.

Implicating things further: Pain can beget more pain. For example, an injury may turn up the volume on your pain response to future injuries. Stress may cause pain to persist long after an injury has healed. And if your back twinges and you start imagining all the ways it could get worse, that fear can magnify your pain, which may lead you to avoid physical activity, which then makes the pain even worse. Experts call this the pain cycle.

Here, Dr. Sarno’s notion of the brain triggering pain was partially right. Research shows that catastrophizing can turn acute pain into chronic pain and increase activity in brain areas related to anticipation of and attention to pain. This is one of the reasons clinicians are starting to treat pain disorders similarly to, say, anxiety disorders, encouraging patients to exercise so they can overcome their fear of movement. Whereas a socially anxious patient might take small steps toward talking with strangers, for instance, a patient with back pain might start jogging or cycling.

You can find the off switch.

The bottom line, according to Dr. Howard Schubiner, a protégé of Dr. Sarno, is that “all pain is real, and all pain is generated by the brain.” Today Dr. Schubiner is the director of the Mind Body Medicine Program in Southfield, Mich., and a clinical professor at the Michigan State University College of Human Medicine.

“Whether pain is triggered by stress or physical injury, the brain generates the sensations,” he said. “And — this is a mind-blowing concept — it’s not just reflecting what it feels, it’s deciding whether to turn pain on or off.”

So, by this rationale, all pain is in both the body and the brain. Which is why, when my adductor stopped hurting in July after eight weeks of physical therapy, I didn’t expend too much mental energy trying to figure out what had worked: the exercises themselves, my physical therapist giving me the go-ahead to keep exercising, the once-a-week opportunity to talk with her about my recent move and the other stressors potentially contributing to my pain or (most likely) all of the above.

In the end, Dr. Sarno was right about exercise aiding, not hampering, recovery and about the link between emotional and physical pain. But not all chronic pain is psychological. Dr. Sarno’s Freudian treatment is far from the only one that works. And few scientists would say that our brain uses pain to distract us from negative emotions (and definitely not by cutting off blood flow to muscles).

I still think of Dr. Sarno as a savior, and I continue to recommend his books to friends and family; some have read them — and had success — while others have politely declined. Yes, Dr. Sarno almost certainly oversimplified and overemphasized the psychological origins of pain. But he also helped me see that both the mind and the body are responsible for our physical suffering. And that we’re not powerless to change it.

Project Veritas and the Line Between Journalism and Political Spying

Documents show how the conservative group worked with lawyers to gauge how far its deceptive reporting practices could go before running afoul of federal laws.

 

By Adam Goldman and Mark Mazzetti NY Times

WASHINGTON — Hours after F.B.I. agents searched the homes of two former Project Veritas operatives last week, James O’Keefe, the leader of the conservative group, took to YouTube to defend its work as “the stuff of responsible, ethical journalism.”

“We never break the law,” he said, railing against the F.B.I.’s investigation into members of his group for possible involvement in the reported theft of a diary kept by President Biden’s daughter, Ashley. “In fact, one of our ethical rules is to act as if there are 12 jurors on our shoulders all the time.”

Project Veritas has long occupied a gray area between investigative journalism and political spying, and internal documents obtained by The New York Times reveal the extent to which the group has worked with its lawyers to gauge how far its deceptive reporting practices can go before running afoul of federal laws.

The documents, a series of memos written by the group’s lawyer, detail ways for Project Veritas sting operations — which typically diverge from standard journalistic practice by employing people who mask their real identities or create fake ones to infiltrate target organizations — to avoid breaking federal statutes such as the law against lying to government officials.

The documents show, for example, Project Veritas operatives’ concern that an operation launched in 2018 to secretly record employees at the F.B.I., Justice Department and other agencies in the hope of exposing bias against President Donald J. Trump might violate the Espionage Act — the law passed at the height of World War I that has typically been used to prosecute spies.

“Because intent is relevant — and broadly defined — ensuring PV journalists’ intent is narrow and lawful would be paramount in any operation,” the group’s media lawyer, Benjamin Barr, wrote in response to questions from the group about using the dating app Tinder to have its operatives meet government employees, potentially including some with national security clearances.

In a separate July 2017 memorandum, Mr. Barr emailed a representative of the group that the criminal statute involving false statements to federal officials “continues to be an expansive, dangerous law that inhibits Veritas’s operations.”

The documents give new insight into the workings of the group at a time when it faces potential legal peril in the diary investigation — and has signaled that its defense will rely in part on casting itself as a journalistic organization protected by the First Amendment.

The F.B.I. last week searched the homes of Mr. O’Keefe and two former Project Veritas operatives — Eric Cochran and Spencer Meads — as part of the investigation into the reported theft of Ms. Biden’s diary. Mr. O’Keefe has acknowledged receiving a grand jury subpoena in the case.

Mr. O’Keefe and his lawyer, Paul Calli, revealed new details about the diary investigation and F.B.I. search to Sean Hannity on Fox News on Monday. During the interview, Mr. Calli said that Project Veritas had paid for the right to publish the diary but was unable to confirm it belonged to Ms. Biden and ultimately decided not to go ahead with a story about its contents. Excerpts from the diary were later published by another conservative website.

One of the crimes listed on Mr. O’Keefe’s search warrant was “transporting material across state lines,” his lawyer said. There is a criminal statute against taking stolen goods from one state to another.

Mr. O’Keefe said the F.B.I. took his phones, which had confidential donor and source information. He said that neither he nor his group had done anything wrong, and that the F.B.I. searches were an assault on the First Amendment.

The legal documents obtained by The Times were written several years ago, at a time when Project Veritas was remaking itself from a small operation running on a shoestring budget to a group more closely modeled on a small intelligence-gathering organization.

During the Trump administration, the group saw a flood of new donations from both private donors and conservative foundations, and hired former American and British intelligence and military operatives to train Project Veritas agents in spy craft.

In a statement issued by one of its lawyers, Project Veritas said it “stands behind these legal memos and is proud of the exhaustive work it does to ensure each of its journalism investigations complies with all applicable laws.”

The statement said the work “reflects Project Veritas’s dedication to the First Amendment, which protects the right to gather information, including about those in power.”

Project Veritas is suing The New York Times over a 2020 story about a video the group made alleging voter fraud in Minnesota.

Most news organizations consult regularly with lawyers, but some of Project Veritas’s questions for its legal team demonstrate an interest in using tactics that test the boundaries of legality and are outside of mainstream reporting techniques.

In a February 2018 memo, Mr. Barr said he was writing in response to questions from the group about the use of Tinder “to meet prospective agents of the ‘Deep State’ or those with national security clearances.”

The document discussed the perils of the Espionage Act at length, and warned that Project Veritas should not try to obtain or publish any information related to national security. “In addition, as more facts and developments occur in these investigations, further legal consultation is advised,” the memo stated.

The Times previously reported that in the summer of 2018, Project Veritas had provided the money to rent a luxurious house in Georgetown, a convenient base for female operatives going on dates with federal employees at the F.B.I., State Department and Justice Department, among other agencies. In September of 2018, Project Veritas released a video as part of a series called “Deep State Unmasked.”

One of the documents mentions “Richard,” a likely reference to Richard Seddon, a former MI6 officer. Mr. Seddon was recruited to join Project Veritas in 2016 by Erik Prince, the military contractor and brother of Betsy DeVos, who served as education secretary during the Trump administration.

In 2017, Mr. Seddon trained Project Veritas operatives at Mr. Prince’s family ranch in Wyoming, according to training documents and former operatives. He helped oversee a surge in hiring, often interviewing prospective employees at an airport in Cody, Wyo., close to the Prince ranch.

Mr. Seddon, who lives in Wyoming, left Project Veritas in mid-2018 to conduct his own political spying operations in Wyoming and Colorado against Democrats and Republicans who were considered insufficiently loyal to Mr. Trump. That operation was funded at least in part by Susan Gore, a wealthy conservative and an heiress to the Gore-Tex fortune, according to people familiar with her role. (Ms. Gore has publicly denied funding the operation.)

She is the founder of a conservative organization called the Pillar of Law Institute, of which Mr. Barr, the Project Veritas lawyer, is president.

In another legal document, one about attending campaign events where the Secret Service vets attendees, the group was told its operatives could not use phony names or false pretenses.

“I believe going backstage or to closed events that require identification to the Secret Service is an invitation for a 1001 charge,” the memo said, referring to the federal law against lying to government officials, adding that in some cases, the group might be able to prevail in court using a First Amendment challenge.

The memo warned the Project Veritas employee: “I do not expect getting as close to the line as you suggest, broadly speaking, is a good opportunity for a test case.”

Mr. O’Keefe likes to describe himself as a crusading journalist exposing wrongdoing, targeting liberal groups and Democratic politicians. He has boasted on social media that he is building the “next great intelligence agency.”

Mr. O’Keefe’s operatives use fake identities and secret recordings to ensnare unsuspecting targets.

In the legal documents, Mr. Barr repeatedly refers to Project Veritas employees as “operatives” or “agents,” as well as “journalists.”

In 2017, Project Veritas began airing undercover footage of Times employees in a series called “American Pravda.” In one case, a Times editor in London was secretly recorded by two operatives who were identified by a former Project Veritas employee as James Artherton and Thor Holt. Mr. Holt did not respond to a request for comment and Mr. Artherton could not be located.

The documents show that Project Veritas had sought legal advice from a lawyer in London about conducting an undercover investigation using “covert recording of audio and video.”

The lawyer said there was “no problem” using a fake name and said the proposed operation would, “most likely, be lawful in England and Wales.”

The Times provided copies of some of the legal memos to Bill Grueskin, a professor at the Columbia Journalism School and former deputy managing editor of The Wall Street Journal and executive editor at Bloomberg News.

Mr. Grueskin, who has written about Project Veritas, said that some of Mr. Barr’s memos provided “pretty good advice,” particularly about when it is permitted to record phone conversations and other tactical recommendations.

He said that the undercover nature of Project Veritas’s work was more problematic.

“It opens you up to the charge that you’ve been intentionally deceptive and you lose your moral standing,” Mr. Grueskin said. “Every newsroom I’ve ever worked in has basically said undercover journalism was unacceptable. I’ve never had a reporter tell me he wanted to pose as somebody they were not.”

In 2010, Mr. O’ Keefe and three others pleaded guilty to a federal misdemeanor after admitting they had entered a government building in New Orleans under false pretenses as part of a sting operation.

In 2016, a Project Veritas operative infiltrated Democracy Partners, a political consulting firm, using a fake name and fabricated résumé, and made secret recordings of the staff. In his book, “American Pravda: My Fight for Truth in the Era of Fake News,” Mr. O’Keefe said the operative was “literally living out her character in America’s capital city much as Americans overseas did in Moscow during the Cold War.”

Democracy Partners later sued Project Veritas. In a ruling last month, a U.S. District Court judge said that Democracy Partners could refer to Project Veritas’s conduct as a “political spying operation” in the upcoming trial.

Michael S. Schmidt contributed reporting.