by David Goldberg

Everyone poops. And everyone makes lots of different types of poops. But what does it mean, say, if your poo comes out like pebbles, or if you go to wipe and there's no residue? These mysteries, among many others, are solved in the new book, What's Your Poo Telling You? The book is the culmination of what began as a collection of emails back and forth between poo-a-phile Josh Richman and his friend, gastroenterologist Anish Sheth.

"There isn't a shortage of people who after reading this book have suddenly felt comfortable talking about this stuff with us."

Richman and Sheth have put together a fecal almanac that gives humorous and informative answers to pressing queries such as: "Why do I sometimes have to poo again right after I get off the toilet?" and "What does it mean if my poo looks like soft-serve ice cream?" In the following interview, edited for clarity, they tell Gelf how their project got its start, why George Bush keeps his poos on lockdown, and whether there will ever be a What's Your Poo Telling You, Number Two.

Gelf Magazine: Tell me how this whole thing came about.

Josh Richman: It started as a quirky idea. It was a personal interest. I had always been curious as to the biological causes of the different types of poos. I started telling a few friends that I should write a book about this with a GI doctor and explain stuff that has thus far been unexplained. One of the first conversations I had about this was with my brother-in-law, who was best friends in medical school with Anish. Anish and I had been in undergrad together but hadn't stayed in touch after graduating. It essentially came together after we reconnected, and I talked to him about the idea. He latched onto it right away, we had a couple conversations, and Anish sent me an email of a sample entry and just nailed the exact vision for the way it would go: the name (for each type of poo), the synonyms, and the humorous explanation with the medical definition. We had this similar vision, and the book flowed from there.

GM: So how did you guys propose this to a publisher?

JR: Because humor books are essentially about execution rather than ideas, we wrote three quarters of the book before we got to the stage of pitching it. We had written a lot of the entries and a lot of the nuggets just going back and forth over email. Then we put together a proposal, sent it to a few agents who came recommended from friends of ours who are writers. Of the three or four agents we sent it to, two of them wanted to represent us, and then we signed on with one of them and she shipped it out to some publishers and two publishers wanted to publish it.

GM: Can you describe the writing process? What were your individual chores?

Anish Sheth: I think the beauty of the process - a lot of which took place over email over several months' time - was that while the medical knowledge came from me and Josh did a lot of the humorous writings and synonyms, it's really hard to say where was Josh's hand and where was mine. He definitely added some things to the doctor's side of it and I added some to the entries. I think by the end, it's really hard to divide up the book into which part was done by whom. I think that's what makes it successful: It's readable to the layperson and funny but also informative.

JR: Anish gets all the credit for the hardcore medical part. Everything else was really a collaborative effort.

AS: My interest in poo is not what led me to choose the field of gastroenterology - there are other things. But I can think back as early as high school and college my friends and I devising something called the TQI, the Tut Quality Index, a quantitative way to evaluate the satisfaction of the bowel movement. It dealt with everything from the size to how you felt afterwards. I think Josh and I both found something of interest about it when we were growing up.

GM: How are you doing publicity for the book?

JR: My goal all along was twofold: to get to No. 2 on the New York Times bestseller list and to have an appearance on Howard Stern. Thus far, we haven't done either. There's been a lot of interest, from magazines and newspapers. Borders and some of the other bookstores are planning to push it as part of their Fathers' Day display. What's interesting is that it runs a wide gamut. A lot of the health editors are latching onto it, and there is the obvious humor aspect of it, as well. It's targeting a broad section of customers. If you look at the market size for the book; there are 300 million people in America, and every single one of them poos. Whether you're young or old, no matter what you do for a living, you can learn something from it and enjoy it.

GM: Do you guys have any favorites of the poos you describe?

JR: Good parents could never say that they have a favorite among any of their children. I personally love the "poo-phoria" and "monster poo" and "déjà poo."

AS: The "hanging chad," in terms of the laugh-out-loud humor of it, takes the cake. I think a lot of the other ones are interesting; I think "poo-phoria" is an experience that I hope most people can identify with at some point. But in terms of the humor aspect, the hanging chad made me laugh out loud while I was reading it.

JR: I learned a lot from the "poo-thbrush" and the "clean sweep." These are all heavily loaded with information.

GM: Anish, you're a doctor. Can you explain the scientific method for determining some of the facts you present in the book, like "The average person farts 10 times per day, releasing 705 CCs of gas into the atmosphere"?

AS: Believe it or not, the golden age in terms of medical research on this stuff was probably 40 or 50 years ago. A lot of the things that we take for granted in terms of physiology comes from studies of medical students and interns. A lot of these studies like, "how do we know what the normal number of times we go to the bathroom is?" were done on small numbers of "normal people" without any diseases. The fart thing that you mention was basically done on a handful of medical students in a lab where they captured all the air that was emitted and measured it. People also always wonder, "I go to the bathroom three times a day. Is that normal?" The way we determine what's normal is by looking at a sample and doing basic statistics. That's how we came up with normal being anywhere from three poos per day to three per week. A lot of these were physiology studies done on small samples of people 40, 50, 60, 70, 80 years ago.

GM: You mentioned in the book that South Asians poo about three times more than other folks due to their diet. Does that mean that they go three times more often or that their poos are bigger?

AS: The latter is definitely true. I suspect it's both. The main issue is that the thing that lends bulk to your stool is fiber, mainly insoluble fiber. Things like corn that just come out. Historically, it makes sense that populations and individuals that consume more roughage end up having more weight to their stool. Because what lends stool weight is not just these corn particles but is the water content of the stool. The greater amount of indigestible products you have in your stool, the greater amount of water that will be held inside the intestine with it.

We don't cover this in the book, but you've probably heard that eating a high-fiber diet may prevent colon cancer. This comes from looking at different countries and cultures. In India, colo- cancer rates are very low compared to those of the Western world. The high-fiber diet is one of the things that people use to explain it. They're consistently flushing out their intestines and their colons and this may account for why there are lower colon-cancer rates and other things. A lot of the stuff in the book comes down to fiber in one way or another.

GM: For a lot of the different types of poo you describe, there are two possibilities about what they're telling the poo-er. Either it's nothing to worry about and it's funny, or the person has some sort of grave problem, like internal bleeding or cancer. Is there a quick way to tell or should you get yourself checked out?

AS: I think it probably depends. Any time you see blood in the stool, as a physician, I want that to be evaluated. For everything in medicine, the same symptom can either represent the best or the worst. If one time in your life you see blood in your stool and you're a 35-year-old healthy guy, then you probably donít need to worry about it. If you have diarrhea for a couple days, it's probably not a big deal, but if it goes on...

If I had to give a hedging answer, it would be that if you otherwise are healthy and it goes away, it was probably due to something you ate or stress or some medication you were taking, and it's probably not reason to worry.

GM: I remembered when I was looking at this book that there were a number of "type of poo" lists out there on the internet. (Here's an example.) Obviously, they are far less detailed and donít get into the "what does this mean" aspect, but did you guys worry about overlapping with them as you were doing it?

JR: What makes this unique is that it's not just potty humor. While that is intertwined, the real intent was to have a higher-brow level of humor and information than anything else that had been out there. There are a lot of poo books out there that were targeted towards young children to help them understand that it's OK. Everyone Poops is an international bestseller. The interest was seeded as we were young children. But now this book fills the void by looking at this in a more funny and informed way.

GM: Is there a line between funny and educated and just plain gross? Did your editor make you take out anything that was over the line?

JR: No, we wanted to walk this line ourselves. One of our goals was to get rid of this social stigma and throw it out there and say this is normal to talk and learn about. We didnít do anything that was too disgusting because that wasnít the intent of the book.

GM: That's interesting, because this doesn't gross me out, but something like ratemypoo.com [Eds. Note: only click if you don't mind seeing a stranger's poo]ówhich is a bunch of pictures of people's poopsóreally does.

JR: That's why we illustrated it, rather than use photographs.

AS: We had a very similar vision in terms of walking that line. By the time we went to publishers, I donít recall any instance where somebody said, this is crossing the line. We had gone back and forth amongst ourselves. Even with the illustrations, we had sort of decided that we wanted to be understated about the poo and we didnít want this to be some sort of gross picture book that would turn people off.

JR: At no point did we seriously discuss including scratch 'n' sniff or anything like that.

GM: On the "hanging chad" you mentioned earlier, you recommend wiping front to back to "avoid contaminating the genital area." Isn't that a good recommendation in general? Or do you go both ways?

AS: This is getting way too specific, but I think there's probably no difference in terms of detaching the poo in terms of cleanliness. Females from a young age are always taught to always wipe front to back for this contamination reason, though. I think for guys, it's not as big a deal. I don't know that there's a physics reason for going one way or the other.

GM: What about crumpling versus folding your toilet paper?

JR: I had heard that there were studies done on people's preferences between the two, but I did some searches and couldn't find anything like that. Since the book has come out, a lot of people have asked about a whole bunch of other poo-related things.

GM: Is there going to be a sequel?

JR: The book is already chock-full of information. If there is a second release, there isn't a shortage of people who after reading this book have suddenly felt comfortable talking about this stuff with us.

GM: Going back to the medical stuff I was talking about before, how many times do you need to be a victim of a "sneak attack" (a.k.a. a "shart") before there's a problem?

AS: I would say that - and I'm not speaking from personal experience necessarilyósneak attacks almost always occur in this Montezuma's Revenge, traveler's diarrhea situation. Everything is working fine, and you think you're going to pass some gas, but there's some loose stool in there and the next thing you know, you get a sneak attack. If that happens, I think things are cool, but if it lasts longer and you keep getting hit, then that's a problem. Either it means that your diarrhea is continuing or for some reason the sphincter or muscles or valves that should be able to tell whether there's gas or liquid in the vault is going wrong. One time, I think you're good. If it happens repeatedly over a prolonged period of time, then that becomes a different issue.

GM: At the end of the book, you write that George Bush's poo is disposed of securely. What information would would-be-evil-doers be able to find out from analyzing his poo?

AS: The main thing that people could do is get Bush's DNA. There are cells that line our intestinal tract that every seven days or so turn over. Part of what's in stool is all of this debris from these dead cells. With the right technology, you could theoretically isolate George Bush's DNA. That would be valuable for a lot of reasons. To have DNA on file would be helpful in terms of identifying things down the road. There are a lot of genetic diseases that people could screen for. They could also tell other things about his general health, if he has any underlying gastrointestinal diseases or malignancies. If he's malabsorbing certain things, it may suggest that he has some liver or pancreatic disease.

In reality, if the guy's healthy and there's nothing wrong with him, it's probably not a huge deal. But having the DNA of the leader of the "Free World" could become useful as new genetic testing and DNA analysis becomes more widespread and we're able to tell more things about people. There are certain mutations that predispose people to certain types of cancer. In a year or so, they're going to come out with a stool DNA test to see if people are at risk for developing colon cancer.

JR: One of the things Anish mentioned when we discussed this was that you could also see what types of medication he was taking. It's another window into his health. If we had a sampling of Castro's stool, for example, we would know what's going on with him.

GM: Going back to less medical stuff, how big does a poo need to be before I can bring in others to look at it? Sometimes I take what I think are really big poos, but am not sure. Is there an absolute value I should be shooting for?

JR: The first differentiator is that it has to break the water. That's the first barrier it has to clear.

AS: An asterisk on the breaking the water thing is that it can't be a floater. That's cheating. One part of it has to be resting on the bottom of the bowl.

JR: And then it also has to have the girth. You can't call someone in and have them say, "Oh, I've done something three times that big."

AS: It's sort of a gut feeling. When you have a poo, the feeling afterwards is part of it. If you unleash something that makes you feel empty from the inside out, then that's something that you should probably be sharing with other people.