A few years ago, I always had this thing happening to me, especially at family gatherings like teas with aunts and uncles or something like this. When people come up to you, and they ask you, "So, what are you doing?" And I would have this magical one-word reply, which would make everybody happy: "Medicine. I'm going to be a doctor." Very easy, that's it, everybody's happy and pleased. And it could be so easy, but this effect really only lasts for 30 seconds with me, because that's then the time when one of them would ask, "So, in what area of medicine? What specialty do you want to go into?" And then I would have to strip down in all honesty and just say, "OK, so I'm fascinated with the colon. It all started with the anus, and now it's basically the whole intestinal tract."
幾年前, 我一直被某件事纏身, 特別是在家庭聚會時, 比如和姑姑叔叔喝茶之類的場合。 當人們走向你 並問道:「你做什麼工作?」 而我會以一個魔法般的詞來回應, 總能讓每個人都開心滿意: 「醫學。 我將會成為醫生。」 非常簡單,就這樣, 大家都開心愉快。 雖然很容易, 但這個效應對我來說 只會持續三十秒, 因為時間一到,就會有個人發問: 「所以,是醫學的哪個領域? 你想要專攻哪方面?」 接著,我就得很坦誠地說: 「好的,我被結腸深深吸引。 它是從肛門開始, 基本上它就是整個腸道。」
(Laughter)
(笑聲)
And this would be the moment when the enthusiasm trickled, and it would maybe also get, like, awkwardly silent in the room, and I would think this was terribly sad, because I do believe our bowels are quite charming.
就在這個時刻, 熱情就開始變得稀落了, 也可能會在房間中出現尷尬的沉默, 我會覺得這非常讓人感傷, 因為我真心覺得 我們的腸子相當迷人。
(Laughter)
(笑聲)
And while we're in a time where many people are thinking about what new superfood smoothie to make or if gluten is maybe bad for them, actually, hardly anyone seems to care about the organ where this happens, the concrete anatomy and the mechanisms behind it. And sometimes it seems to me like we're all trying to figure out this magic trick, but nobody's checking out the magician, just because he has, like, an embarrassing hairstyle or something. And actually, there are reasons science disliked the gut for a long time; I have to say this.
雖然在這個時代,許多人會去想 要做什麼冰沙超級食物 (superfood) , 或者麩質是否對身體有害, 但事實上,似乎很少有人會在乎 承擔這些活動的身體器官、 具體的解剖學以及其背後的機制。 有時,就我看來, 就像我們都在試著看穿 這個魔術把戲, 卻沒有人去看魔術師, 只因為他有著 令人尷尬的髮型之類的。 其實, 科學界長期以來 不喜歡腸道的原因很多, 我必須得這麼說。
So, it's complex. There's a lot of surface area -- about 40 times the area of our skin. Then, in such a tight pipe, there are so many immune cells that are being trained there. We have 100 trillion bacteria doing all sorts of things -- producing little molecules. Then there's about 20 different hormones, so we are on a very different level than our genitals, for example. And the nervous system of our gut is so complex that when we cut out a piece, it's independent enough that when we poke it, it mumbles back at us, friendly.
它很複雜。 它有巨大的表面積, 差不多是皮膚表面積的四十倍。 在這麼緊的管道中, 有非常多的免疫細胞在那裡受訓。 有一百兆個細菌在做各種事情, 產生小分子。 還有大約二十種不同的賀爾蒙, 所以,例如和生殖器相比, 它又是很不一樣的層級。 而腸子的神經系統非常複雜, 當我們切下一小片時, 它是獨立的,當我們戳它, 它會很友善地咕噥回應我們。
(Laughter)
(笑聲)
But at least those reasons are also the reasons why it's so fascinating and important.
但至少,那些理由也是 它為什麼如此迷人且重要的原因。
It took me three steps to love the gut. So today, I invite you to follow me on those three steps. The very first was just looking at it and asking questions like, "How does it work?" and "Why does it have to look so weird for that sometimes?" And it actually wasn't me asking the first kind of these questions, but my roommate. After one heavy night of partying, he came into our shared-room kitchen, and he said, "Giulia, you study medicine. How does pooping work?"
我花了三個步驟,來愛上腸子。 今天,我邀請各位跟著我 一起經歷這三個步驟。 第一步,就是看著它, 然後問像這樣的問題: 「它如何運作?」 及「為什麼它得長得如此怪異?」 其實並不是我自己 問前面第一種問題, 而是我室友。 在一場宿醉的狂歡之夜後, 他來到我們共用的廚房, 他說:「茱莉亞,你讀的是醫學。 拉屎是怎麼運作的?」
(Laughter)
(笑聲)
And I did study medicine but I had no idea, so I had to go up to my room and look it up in different books. And I found something interesting, I thought, at that time. So it turns out, we don't only have this outer sphincter, we also have an inner sphincter muscle. The outer sphincter we all know, we can control it, we know what's going on there; the inner one, we really don't. So what happens is, when there are leftovers from digestion, they're being delivered to the inner one first. This inner one will open in a reflex and let through a little bit for testing.
我的確讀醫學,但我不知道答案, 所以我回房查不同的書籍。 在那時我認為自己 發現了很有趣的東西。 結果是,我們不只有這個外括約肌, 我們還有內括約肌。 我們都知道外括約肌, 我們可以控制它, 我們知道那裡的狀況; 內括約肌,我們就不了解了。 是這樣的: 當消化之後還有殘餘物, 它們會先被運送到內括約肌。 內括約肌會反射性地打開, 讓一點點殘餘物通過,做測試用。
(Laughter)
(笑聲)
So, there are sensory cells that will analyze what has been delivered: Is it gaseous or is it solid? And they will then send this information up to our brain, and this is the moment when our brain knows, "Oh, I have to go to the toilet."
那裡有感覺細胞 分析被運送來的是氣體還是固體? 接著這資訊會被送到大腦, 這時,我們的大腦就會知道: 「喔,我得去上廁所。」
(Laughter)
(笑聲)
The brain will then do what it's designed to do with its amazing consciousness. It will mediate with our surroundings, and it will say something like, "So, I checked. We are at this TEDx conference -- "
頭腦接著就會用它不可思議的意識, 著手做它該做的事。 它會在我們和環境之間調停, 說像這樣的話: 「我確認了。 我們正在 TEDx 會議上──」
(Laughter)
(笑聲)
(Applause)
(掌聲)
Gaseous? Maybe, if you're sitting on the sides, and you know you can pull it off silently.
氣體? 也許可以,如果你的座位是在邊沿, 且你知道你可以安靜地釋放的話。
(Laughter)
(笑聲)
But solid -- maybe later.
但固體── 也許晚點吧。
(Laughter) Since our outer sphincter and the brain is connected with nervous cells, they coordinate, cooperate, and they put it back in a waiting line --
(笑聲) 因為我們的外括約肌和頭腦 是通過神經細胞連結的, 它們互相協調、合作, 它們會把固體推回,讓其等候,
(Laughter)
(笑聲)
for other times, like, for example, when we're at home sitting on the couch, we have nothing better to do, we are free to go.
在其他時間釋放, 比如,當我們在家 坐在沙發上的時候, 我們沒別的事要做, 我們就可以釋放了。
(Laughter)
(笑聲)
Us humans are actually one of the very few animals that do this in such an advanced and clean way. To be honest, I had some newfound respect for that nice, inner sphincter dude -- not connected to nerves that care too much about the outer world or the time -- just caring about me for once. I thought that was nice. And I used to not be a great fan of public restrooms, but now I can go anywhere, because I consider it more when that inner muscle puts a suggestion on my daily agenda.
沒有幾種動物能夠 如此進階且乾淨地排便, 而我們人類是其一。 老實說,我對於這位 出色的內括約肌同志 又增添了新的敬意。 它沒有和神經連結── 而神經太在乎外在世界或時間了── 多麽難得,它獨獨關心我。 我覺得那樣很棒。 我以前對公共廁所敬謝不敏, 但我現在在哪都能解放, 因為當內括約肌在我的 日議程中提出一條建議時, 我會多多體貼它一下。
(Laughter)
(笑聲)
And also I learned something else, which was: looking closely at something I might have shied away from -- maybe the weirdest part of myself -- left me feeling more fearless, and also appreciating myself more. And I think this happens a lot of times when you look at the gut, actually. Like those funny rumbling noises that happen when you're in a group of friends or at the office conference table, going, like, "Merrr, merrr..." This is not because we're hungry. This is because our small intestine is actually a huge neat freak, and it takes the time in between digestion to clean everything up, resulting in those eight meters of gut -- really, seven of them -- being very clean and hardly smelling like anything. It will, to achieve this, create a strong muscular wave that moves everything forward that's been leftover after digestion. This can sometimes create a sound, but doesn't necessarily have to always. So what we're embarrassed of is really a sign of something keeping our insides fine and tidy.
我也學到了其他的: 近看某樣我可能羞於面對的東西, 也許是我身體最怪異的那部份, 會讓我覺得更無懼, 也更懂得欣賞我自己。 我認為,這種情況其實常常會發生, 就在你看著腸子的時候。 比如當你剛好在一群朋友之中時, 它發出那好笑的咕嚕聲, 或是在辦公室的會議中, 發出:「嚒嚒嚒…」 這並不是因為我們餓了。 這是因為我們的小腸其實 是個很愛乾淨的怪胎, 它會在兩次消化之間的 空檔進行大掃除, 造成那八公尺的腸子── 其實是其中的七公尺── 變得非常乾淨,幾乎沒有味道。 為了做到這一點, 它會造成很強力的肌肉抖動, 把消化後的殘餘物通通向前推。 有時候就會產生聲音, 但不見得一定如此。 所以這讓我們感到尷尬的聲音, 其實是個徵兆, 表示有某樣東西在保持 我們內部的健康和清潔。
Or this weird, crooked shape of our stomach -- a bit Quasimodo-ish. This actually makes us be able to put pressure on our belly without vomiting, like when we're laughing and when we're doing sports, because the pressure will go up and not so much sideways. This also creates this air bubble that's usually always very visible in X-rays, for example, and can sometimes, with some people, when it gets too big, create discomfort or even some sensations of pain. But for most of the people, is just results that it's far easier to burp when you're laying on your left side instead of your right.
我們胃部這個怪異彎曲的形狀 有點「鐘樓怪人」的風範。 這形式其實是讓我們 能夠對我們的腹部加壓, 且不會造成嘔吐, 比如當我們大笑、 當我們做運動時, 能夠讓壓力向上,而不太會向旁邊。 這過程也會產生氣泡, 例如在 X 光下,可以看得很清楚, 有些人有些時候, 氣泡會太大, 會造成不適,甚至有痛的感覺。 但對大部份人來說,最終結果是, 就是當你左側臥時, 會比右側臥更容易打嗝。
And soon I moved a bit further and started to look at the whole picture of our body and health. This was actually after I had heard that someone I knew a little bit had killed himself. It happened that I had been sitting next to that person the day before, and I smelled that he had very bad breath. And when I learned of the suicide the next day, I thought: Could the gut have something to do with it? And I frantically started searching if there were scientific papers on the connection of gut and brain. And to my surprise, I found many.
不久後我更進一步, 開始觀察我們的整個身體以及健康。 這其實是在我聽說 某個我稍微認識的人自殺之後的事, 剛好在前一天我曾坐在那個人旁邊, 我聞到他有嚴重的口臭。 當我知道他隔天自殺時, 我心想:有沒有可能和腸子有關? 我瘋狂地開始尋找是否存在 涉及腸子與頭腦間關聯的科學文獻。 讓我驚訝的是,我找到很多。
It turns out it's maybe not as simple as we sometimes think. We tend to think our brain makes these commands and then sends them down to the other organs, and they all have to listen. But really, it's more that 10 percent of the nerves that connect brain and gut deliver information from the brain to the gut. We know this, for example, in stressful situations, when there are transmitters from the brain that are being sensed by our gut, so the gut will try to lower all the work, and not be working and taking away blood and energy to save energy for problem-solving. This can go as far as nervous vomiting or nervous diarrhea to get rid of food that it then doesn't want to digest.
結果是,實情並非 我們想的那麼簡單。 我們通常認為大腦會下指令, 把指令送到其他器官, 它們都得聽命。 但實情比較像是 10% 連結大腦和腸子的神經 會把資訊從大腦傳到腸子。 我們知道,比如在有壓力的狀態下, 我們的腸子感知到了 來自大腦的神經遞質, 腸子就會減緩所有的工作, 不再工作,也不再 消耗太多血液和能量, 就能儲存能量來解決問題。 這有可能呈現的形式包括 神經性嘔吐或神經性腹瀉, 目的是要擺脫掉 它拒絶消化的食物。
Maybe more interestingly, 90 percent of the nervous fibers that connect gut and brain deliver information from our gut to our brain. And when you think about it a little bit, it does make sense, because our brain is very isolated. It's in this bony skull surrounded by a thick skin, and it needs information to put together a feeling of "How am I, as a whole body, doing?" And the gut, actually, is possibly the most important advisor for the brain because it's our largest sensory organ, collecting information not only on the quality of our nutrients, but really also on how are so many of our immune cells doing, or things like the hormones in our blood that it can sense. And it can package this information, and send it up to the brain. It can, there, not reach areas like visual cortex or word formations -- otherwise, when we digest, we would see funny colors or we would make funny noises -- no. But it can reach areas for things like morality, fear or emotional processing or areas for self-awareness.
可能更有趣的是 90% 連結腸子和大腦的神經纖維 會把資訊從我們的腸子傳送給大腦。 若你稍微想想, 這的確合理,因為 我們的大腦是很孤立的。 它位於被厚皮膚包裹的頭骨之內, 它需要資訊才能夠整合出 「我的整個身體的狀況如何?」的感覺。 而腸子實際上可能是大腦最重要的顧問, 因為它是我們最大的感覺器官, 收集的資訊不只是 我們的營養品質好壞, 還包括我們這麼多 免疫細胞的狀況如何, 或像是它能感受到的 血液中賀爾蒙的情況。 它能把這些資訊打包 之後送到大腦去。 而它不會到達大腦中像是 視覺皮質或是言語形成的區域, 否則當我們消化時 可能會看到奇怪的顏色 或是發出奇怪的聲音。 而我們不會。 但它會到達包括像是道德、 恐懼、情緒處理, 或是自我意識的區域。
So it does make sense that when our body and our brain are putting together this feeling of, "How am I, as a whole body, doing?" that the gut has something to contribute to this process. And it also makes sense that people who have conditions like irritable bowel syndrome or inflammatory bowel disease have a higher risk of having anxiety or depression. I think this is good information to share, because many people will think, "I have this gut thing, and maybe I also have this mental health thing." And maybe -- because science is not clear on that right now -- it's really just that the brain is feeling sympathy with their gut.
這確實合理, 當我們的身體和大腦在整合出 「我整身的狀況如何」的感覺時, 腸子對於這個過程做出了一些貢獻。 還有一點也是合理的, 人們如果患了像大腸激躁症 或發炎性腸道疾病之類的, 他們得焦慮症或 憂鬱症的風險也比較高。 我認為這個資訊值得分享, 因為許多人會認為: 「如果我的腸子有問題, 也許我的心理健康也有問題。」 也許──因為科學尚不瞭解這一點── 也許只是他們的大腦在同情腸子。
This has yet to grow in evidence until it can come to practice. But just knowing about these kinds of research that's out there at the moment helps me in my daily life. And it makes me think differently of my moods and not externalize so much all the time. I feel oftentimes during the day we are a brain and a screen, and we will tend to look for answers right there and maybe the work is stupid or our neighbor -- but really, moods can also come from within. And just knowing this helped me, for example, when I sometimes wake up too early, and I start to worry and wander around with my thoughts. Then I think, "Stop. What did I eat yesterday? Did I stress myself out too much? Did I eat too late or something?" And then maybe get up and make myself a tea, something light to digest. And as simple as that sounds, I think it's been surprisingly good for me.
這方面還需要證據才能夠走向實踐。 但是僅僅知道這一類的研究, 它們正在某處進行著, 就對我的日常生活很有幫助。 它讓我對我的心情有不同的看法, 不再把很多事情都歸為外因。 我常常覺得,在白天我們就像是 一個大腦加上一塊螢幕, 我們往往會向外界尋找情緒的根源, 也許原因是愚蠢的工作或鄰里關係, 但其實心情也可能是內在造成的。 光是知道這點,就對我有幫助, 比如,有時我太早醒來, 我會開始擔心,並胡思亂想。 接著我會想:「停。我昨天吃了什麼? 我讓我自己太過焦慮嗎? 我太晚才吃東西嗎?」之類的。 接著,也許就起床泡壺茶, 弄點清淡的食物來消化。 聽起來很簡單, 但對我是非常有用的。
Step three took me further away from our body, and to really understanding bacteria differently. The research we have today is creating a new definition of what real cleanliness is. And it's not the hygiene hypothesis -- I think many maybe know this. So it states that when you have too little microbes in your environment because you clean all the time, that's not really a good thing, because people get more allergies or autoimmune diseases then. So I knew this hypothesis, and I thought I wouldn't learn so much from looking at cleanliness in the gut. But I was wrong.
第三步讓我從人的身體出發 走向了更遠的地方, 並真正地對細菌有了不同的理解。 我們現今的研究 對於真正的乾淨下了新的定義。 不是衛生假說(hygiene hypothesis), 我想很多人可能知道這假說。 它說的是,當你環境中的微生物過少, 因為你隨時在清理, 那並不是好事, 因為人們會因此較為容易過敏 或患自體免疫疾病。 我知道這個假說, 我心想,只著眼於腸子內的清潔衛生, 我是不會學習到多少東西的。 但我錯了。
It turns out, real cleanliness is not about killing off bacteria right away. Real cleanliness is a bit different. When we look at the facts, 95 percent of all bacteria on this planet don't harm us -- they can't, they don't have the genes to do so. Many, actually, help us a lot, and scientists at the moment are looking into things like: Do some bacteria help us clean the gut? Do they help us digest? Do they make us put on weight or have a lean figure although we're eating lots? Are others making us feel more courageous or even more resilient to stress? So you see, there are more questions when it comes to cleanliness. And, actually, the thing is, it's about a healthy balance, I think. You can't avoid the bad all the time. This is simply not possible; there's always something bad around. So what really the whole deal is when you look at a clean gut, it's about having good bacteria, enough of them, and then some bad. Our immune system needs the bad, too, so it knows what it's looking out for.
結果發現, 真正的清潔並不是要把細菌殺光。 真正的清潔有點不同。 我們來看看事實, 地球上 95% 的細菌不會 也不能傷害我們, 它們的基因使然。 許多細菌其實對我們很有幫助, 目前科學家在研究像這類的題材: 有某些細菌在協助我們清理腸子嗎? 它們協助我們消化嗎? 儘管我們吃得很多, 它們會讓我們變胖或變瘦嗎? 其他細菌是否會讓我們更加勇敢 或是更容易從壓力中恢復? 所以你看,當談到清潔, 有更多的問題要解決。 其實,我認為重點是健康的平衡。 你不可能永遠避開壞事。 不可能就是不可能; 周遭總會有壞事。 所以,當你看著乾淨的腸子時, 重點是裡面要有足夠多的有益細菌, 還要有一些有害細菌。 我們的免疫系統也需要有害細菌, 所以它才能知道它要小心留意什麼。
So I started having this different perspective on cleanliness and a few weeks later, I held a talk at my university, and I made a mistake by 1,000. And I went home and I realized in that moment, I was like, "Ah! I made a mistake by 1,000. Oh God, that's so much, and that's so embarrassing." And I started to think about this, I was like, "Ugh!" And after a while I said, "OK, I made this one mistake, but then I also told so many good and right and helpful things, so I think it's OK, you know? It's a clean thing." And then I was like, "Oh, wait. Maybe I took my perspective on cleanliness further." And it's my theory at the moment that maybe we all do. Take it a bit further than just cleaning our living room, where maybe we make it to sort like a life hygiene. Knowing that this is about fostering the good just as much as trying to shelter yourself from the bad had a very calming effect on me.
所以我開始對清潔有了不同的觀點, 幾週後, 我在我的大學做了一場演說, 我在數字上犯了錯誤, 足足相差1000 倍。 回到家,我了解到在那一刻, 我的反應是:「啊! 我犯了個 1000 倍的錯誤。 天啊,那好嚴重,且好難堪。」 我開始想到這點,然後就:「呃!」 一會兒之後,我說: 「好,我犯了一個錯誤, 但我也說了許多好的東西、 對的東西、有用的東西, 所以我想是沒關係的,對吧? 這是潔淨的。」 接著我又說:「喔,等等, 也許就在剛才,我對清潔的 觀點又進了一步。」 那時,我的理論是, 也許我們都是如此。 再進一步,不只是清理我們的客廳, 也許我們可以做到 有點像是「人生的衛生」。 重點不只是要試著 保護自己不受壞事影響, 同時也要去促進好事, 知道這點,對我有安定的效果。
So in that sense, I hope today I told you mostly good and helpful things, and thank you for your time, for listening to me.
就那個意義來說, 我希望今天我告訴各位的 大部份是好的、有用的東西, 謝謝你們花時間傾聽。
(Applause)
(掌聲)