最常回放的时刻：你真的对麸质不耐受吗？可能是这个原因！

关于腹胀、不适和规律消化这些问题，如果我出现其中任何一种情况，是不是理论上说明身体出了什么问题？

On this point about bloating, discomfort, regular digestion, if I have one of those things, does that theoretically mean that something is not right?

每个人偶尔都会胀气。

Everyone gets bloated once in a while.

所以，说你绝对不能有任何不适症状，这并不公平。

So I think it would be unfair to make it sound like you should never have any adverse symptoms at all.

但如果持续时间很长的话。

But if it's prolonged.

但如果持续很久，成了慢性问题，比如你每天早上醒来都希望今天能好过一点，

But if it's prolonged, if it's a chronic health issue, if you're the type of person who you wake up in the morning and you say, I hope today's going to be a good day.

希望今天不用再为这个问题烦心，

I hope I don't have to deal with that specific issue.

那就有问题了。

You have a problem.

这一点我们早就清楚了。

Like we already know.

那我们就得针对这个问题采取措施。

And then we have to work on that to address that issue.

具体怎么操作，我觉得得因人而异。

And how we go about that I think needs to be on some level personalized.

但我们可以用的手段其实都是一样的。

But the tools that are at our disposal remain the same.

所以关键是要把这些选项摆出来。

So it's just a matter of like, let's put it on the table.

这是你的几种选择。

Here are your choices.

你挑最适合自己的那几项。

You pick which ones are most applicable to you.

对你来说，哪些地方最有改善空间？

Where are the opportunities for you?

但不更了解你的话，我没法直接告诉你。

And I can't tell you that without knowing more about you.

那关于人们老放屁这个问题，你怎么看？

What about this issue of people getting gassy, like farting a lot?

是的。

Yeah.

这通常跟某一种肠道问题有关，还是说也可能由很多不同原因引起？

Is that typically associated with one particular gut issue or is that again, could that be a plethora of issues?

这确实可能由很多不同的原因引起。

So it could be a plethora of issues.

这是个挺常见的问题。

This is a common problem.

如果非得让我挑最首要的原因，那就是便秘。

If I have to like start with what is my number one thing, it's constipation.

没错。

For sure.

百分之百。

A 100%.

现在有很多听节目的人其实便秘了，但他们自己都不知道，因为他们每天都有排便，就以为排便频率就是标准。

There are so many people who are listening right now that are constipated and they don't even know it because they poop every day and they think that how often they poop is the definition.

但其实不是这样的。

And that's not true.

便秘指的是你的肠道没有彻底排空。

So constipation is what happens when you're not adequately emptying your bowels.

这可能是排便次数的问题，但也可能是排得不彻底。

And that could be a frequency problem, but it could also be that it's a partial poop.

哦，原来如此。

Oh, okay.

我以前以为便秘就是完全拉不出来，上厕所也排不出东西。

Because I thought constipation was if you just haven't been, you can't go, you go to the toilet, nothing comes out.

你别误会我的意思。

Look, don't get me wrong.

如果你一周都不排便，那肯定是便秘了。

If you don't poop for a week, know you're constipated.

我不用再问更多问题了。

I don't need to ask any more questions.

如果你一周才一次，但有些人隔天一次，那对他们来说就是常态。

If you go a week, but if it's, there are people who they poop every other day, that's their normal.

他们感觉挺好的。

They feel fine.

没有任何肠胃不适。

They don't have any gut symptoms.

根本不算便秘。

They don't have a constipation problem.

这样就没问题。

We're okay.

对吧？

Right?

所以排便频率并不是唯一标准。

So frequency is not the be all and end all.

这也是其中一部分，对吧？

It's part of the equation, right?

但也有不少人上厕所时，我想描述一下这个场景——别介意啊，我聊排便这事一点都不觉得尴尬。

But there's also people who they poop and I want to sort of paint the picture and forgive me, like I feel very comfortable talking about poop.

这可是我吃饭的本事。

This is what I've done for a living.

他们早上上厕所，但特别费劲。

But they go to the bathroom in the morning, they struggle.

根本没排干净的感觉。

It's not satisfying.

使出浑身力气，才挤出一点点。

They had to work really hard to get a little nugget to come out.

可还是觉得没排完。

And then they feel like they still have to go.

大概四十五分钟后，又得去一趟。

And maybe forty five minutes later, they poop again.

明白了。

Okay.

那不是一次完整的排便。

That's not a new poop.

你是在做部分排便。

You're doing partial poops.

你可能只排了20%到25%。

You're probably doing a 20% or 25% poop.

所以一天里你可能会排三四次。

So you could poop three, four times during the day.

但你的肠道可能并没有完全排空，对吧？

You might not still be fully emptying your bowels, right?

这就解释了为什么有些人明明一天排便三四次，却还在经历腹胀和便秘，还以为自己没问题，毕竟医生，我每天都在排便啊。

And so that's an example of a person who can actually be struggling with bloating and constipation and not think because they're like, Doc, I'm pooping three times a day.

那这种情况下，气体是从哪儿来的？

Where is the gas coming from in that?

为什么人吃了东西之后会放很多屁？

Why do people you eat something and then you fart a lot.

这到底是怎么回事？

What's going on?

气体是跟着大便一起出来的。

So gas travels with poop.

我不是说你，史蒂夫，我是说在听的各位。

You may I don't mean you specifically, Steve.

有些人可能注意到，早上醒来时会不停地放屁。

People listening may notice this, that you wake up in the morning and you're farting like crazy.

这种放屁会一直持续到你完成早上的排便为止。

And that farting continues until you actually have your morning bowel movement.

一旦你有了正常、健康的晨间排便，就会感觉轻松了，也不再放屁了，对吧？

And then once you have your good, healthy morning bowel movement, you feel solid and you're not farting anymore, right?

气体是跟着大便一起排出的。

The gas travels with the poop.

所以，这种情况发生的原因是，你的粪便并不仅仅是食物残渣。

So, and the reason why this happens is because first of all, your poop is not just the leftover remains of your food.

实际上，你的粪便主要由你的肠道菌群构成。

Actually, your poop is predominantly your microbiome.

粪便重量的60%都是微生物。

60% of the weight of your stool is microbial.

真的吗？

Really?

当然是。

Yes.

你说的微生物，是指细菌吗？

When you say microbial, mean like the bacteria?

就是细菌。

The bacteria.

有六成都是细菌。

60% of it is.

我给你举个例子。

Let me give you an example.

假如我把你的饮料里加点可溶性纤维，也就是益生元。

If I took your drink and I added some soluble fiber, which is prebiotic into your drink.

对。

Yeah.

一点渣滓都没有。

There's no grit.

也没有粗糙的纤维。

There's no roughage.

你根本察觉不到它在里面。

You don't even know it's there.

但明天你的排便就会更顺畅、更健康，全是因为我刚才做的这一点。

And you're going to have a bigger, healthier bowel movement tomorrow as a result of what I just did.

为什么呢？

Why?

因为我给你的肠道菌群提供了养分，它们变强了，然后繁殖，因为数量增加了，所以你明天的排便量会更大，对吧？

Because I fed your microbes and they grow stronger and then they multiply and because they multiplied, you have a bigger bowel movement, right?

这就是它的运作原理。

That's the way that that works.

不过别误会，你吃沙拉，排便量也会变大。

Now don't get me wrong, you eat a salad, you're gonna end up with a bigger bowel movement as well.

但其中很大一部分原因，是沙拉里的纤维在滋养这些菌群。

But a big part of that is the fiber within that salad that's feeding these microbes.

它们繁殖、增长，你的排便量就变大了。

They multiply, they grow, and you have a big bowel movement.

如果这就是我的粪便，我手里拿着一块巧克力，其中60%都是这些微生物。

So if that was my stool, my poop, I'm holding a chocolate bar here, 60% of that would be the microbes.

没错，60%都是这些微生物。

60% of that would be the microbes.

对。

Yes.

所以对那个人来说，当粪便堵住不动的时候，这些微生物就会一直待在那里，有充足的时间发酵并产生气体。

So for that person, when the poop is in gridlock and it's not moving through, then those microbes are basically sitting there with unlimited time to ferment and produce gas.

明白了。

Okay.

所以只要它们接触到的东西，它们就会立刻开始分解。

So anything they come into contact with, they're just going to start working on it.

这可不只是和纤维有关的问题。

So it's and it's not just like a fiber thing.

不管接触到什么，比如蛋白质，它们也会发酵，照样产气。

Anything they come into contact with, it could be protein, they will ferment it, they will produce gas.

这就是为什么便秘和胀气、腹胀之间有这么强关联的重要原因之一。

So this is a big part of the reason why constipation is so strongly associated with gas and bloating.

有些人吃了乳制品之类的东西，还有些对麸质敏感的人，常常会放屁比较多。

When people eat dairy and things like that, and I think some people that have gluten, they often tend to get a little bit gassy.

对。

Yeah.

这是便秘吗？

Is that constipation?

胀气和腹胀不光是便秘的问题。

Gas and bloating is not just a constipation issue.

我认为便秘是导致这个问题的首要原因，但还有其他很多可能的因素。

I would argue that constipation is the number one cause of that particular issue, but there's many potential causes.

最主要原因可能是肠道蠕动异常，那就是便秘。

Number one could be motility, that's constipation.

什么是肠道蠕动？

What's motility?

肠道蠕动是指肠道的运动方式。

Motility is the way in which your intestines move.

如果肠道运动太快、节奏紊乱，就会拉肚子。

So if the intestines move too fast and out of rhythm, you get diarrhea.

如果肠道运动太慢、变得迟缓，就会便秘。

If the intestines slow down too much, sluggish, you get constipation.

我们希望肠道保持规律，就像心脏一样，只有在有节奏的时候，它才能发挥最佳状态。

We want the intestines in a rhythm because when they're in a rhythm, just like your heart, that's when they perform their best.

所谓有节奏，其实就是每天排便时间稳定、可预测。

So in a rhythm basically means predictable, consistent daily bowel movements.

这最终正是我们希望达到的状态，对吧？

That's ultimately where we would love to be, right?

这其实也牵涉到一个更广泛的昼夜节律话题，我们以后可以再深入聊。

And that in a way taps into like an entire circadian conversation that we can have later.

你昼夜节律的一部分，就体现在清晨那一次非常顺畅的排便上。

This is a part of your circadian rhythm is a fantastic morning bowel movement.

肠道蠕动只是胀气和腹胀的一个原因。

Motility is just one of the causes of gas and bloating.

第二个原因是肠道菌群。

The second is the microbiome.

如果你的菌群受损或状态不佳，就无法正常履行它的功能。

If you have a microbiome that's damaged and struggling, it's not going to be able to do its job the way it's supposed to.

而它们的工作之一就是处理和分解膳食纤维，因为我们人体本身没有消化纤维的酶。

And part of its job is processing and breaking down fiber because the fiber in our diet, we don't have the enzymes to digest it.

所以纤维穿过肠道，遇到微生物，这些微生物体内有整整六万种我们人类没有的酶。

So it works its way through the intestines, comes into contact with the microbes and the microbes, they have literally 60,000 enzymes that we don't have as humans.

它们会像团队一样协同工作。

They go to work as teams.

纤维不再只是纤维，而是转化成短链脂肪酸。

Fiber stops being fiber, produces short chain fatty acids.

这才是它本来该有的运作方式。

This is the way that it's supposed to work.

当你肠胃不舒服时，微生物也跟着变弱，你却还逼着它们干活，它们根本应付不来。

When your gut is not happy, they're weak, the microbes are weak, and you're asking them to do work and they can't handle that.

结果就是消化不良，进而引发胀气和腹胀。

And you end up with sloppy digestion and that's gas and bloating.

第三个原因可能是你的饮食。

The third thing can be your diet.

你刚才提到乳制品，里面含有乳糖。

So you just mentioned dairy, which contains lactose.

乳糖很容易被发酵，产生气体。

Lactose can be easily fermented to produce gas.

你还提到了麸质。

You mentioned gluten.

麸质本身是一种蛋白质。

Gluten itself is a protein.

那麸质从技术上讲能被发酵吗？

So can gluten technically be fermented?

理论上确实可以发酵，但实际情况并不是这样。

Yes, it could be technically fermented, but that's not really what's going on.

真正发生的是，含麸质的食物——比如小麦、大麦和黑麦——同时还含有另一种碳水化合物，叫果聚糖。

What's happening is that gluten containing foods, which are wheat, barley and rye, also contain these carbohydrates called fructans.

果聚糖其实对我们的肠道菌群特别有好处。

And fructans are actually really good for our microbes.

它们是益生元。

They're prebiotic.

但如果你一次性吃太多，又平时不常吃这类食物，就容易胀气、肚子鼓。

But if you consume a very large amount of them and you're not used to eating these foods, it can cause gas and bloating.

我年轻的时候吃意大利面都没事。

These days, when I was younger, if I had pasta, I was fine.

现在要是吃意大利面，接下来两天都会不舒服。

If I have pasta these days, I'm going to feel it for the next like two days.

真的吗？

Really?

对啊。

Yeah.

说不准。

Don't know.

我根本搞不清到底是怎么回事。

And I don't even know what's going on.

但好像别人怎么吃意大利面都没事。

But then other people can eat pasta as much as they want, it seems.

好奇问一下，你去意大利吃意大利面，会不舒服吗？

Out of curiosity, can you go to Italy and eat pasta and be okay or no?

也是一样吗？

Same thing?

我其实没怎么试过。

I haven't really not really tried.

明白了。

Okay.

据我自己的经验，如果我吃无麸质面包或者无麸质意大利面，感觉确实好很多。

Anecdotally, I think when I remove, when I have like non gluten bread or non gluten pasta, I think I feel much better.

不过我也知道，像你这样的人告诉我，真正对麸质不耐受的人其实只占极少数。

But I'm well aware from speaking to people like yourself that such a small percentage of the population is actually gluten intolerant.

但我们都觉得自己多多少少有点问题。

But we all kind of think we are to some degree.

我觉得问题是，这个比例到底是多少？

I think it's what's the numbers?

是不是有百分之二十的人觉得自己有这个问题？

Is it like twenty percent of people think they are or something?

就拿洛杉矶来说，估计有百分之八十的人都这么想。

So like here in Los Angeles, it's like probably eighty percent of people.

几乎人人都在吃无麸质食品。

Think that Well, like almost everyone's gluten free.

是啊。

Yeah.

对吧？

Right?

但他们其实根本不需要这样。

Which They don't need to be.

反而可能会带来问题。

And actually, it can cause problems.

如果不了解该怎么调整，完全无麸质饮食反而可能带来问题。

It can cause problems to be gluten free unless you know what adaptations to make.

所以你问意大利那边的情况，是想说明什么？

So when you ask that question about Italy, what are you getting at?

在美国，小麦的加工方式有问题，他们允许用草甘膦，也就是农达，来喷洒小麦。

There's a processing issue in The United States involving wheat, which is that they allow the wheat to be sprayed with glyphosate, which is Roundup.

这是一种除草剂。

It's a weed killer.

这么做主要是为了尽快把小麦晒干。

And they do that to basically dry it out as quickly as possible.

你想象一下，你是个农民，种了一片小麦，到了收获季节，对吧？

So imagine for a moment that you're a farmer and you have this field of wheat, you harvest it, okay?

史蒂夫，你有几种选择。

Here are your choices, Steve.

你可以等上几周，让小麦自然风干，然后存起来；也可以喷上这种化学药剂，第二天就干了，马上就能发货。

You can wait a couple weeks and let it dry out naturally in the air and store it somewhere or you can spray it with this chemical and it will be dry by tomorrow and then you can ship it up.

是的

Yeah.

没错

Right.

问题是，草甘膦并没有列在成分标签上。

And the problem is that glyphosate is not on the label.

除非你买的是有机产品，否则你根本无法知道它有没有被喷过。

You would never know whether it's sprayed or not sprayed unless you're buying organic.

如果你买的是有机产品，那按照规定，他们是绝对不能喷这种东西的。

If you buy organic, then by definition, they're not allowed to spray it.

你根本看不出来它是否存在。

You would never know if it's there.

草甘膦之所以被允许存在于我们的食物系统中，是因为人们假设它是安全的——它的工作原理是阻断一种叫作莽草酸途径的生化路径，从而杀死杂草或植物。

The thing about glyphosate is that it's been approved to exist in our food system under the assumption of safety because what it does is it shuts down this thing called the shikimat pathway and that kills weeds or it kills plants.

但我们其实有个应对方法，跟氨基酸有关。

And we have a workaround and it has to do with basically amino acids.

我们人类可以自己合成这些氨基酸，但植物做不到。

We have a workaround where we can basically create those amino acids as humans, but the plants can't.

所以植物死了，我们却能活下来。

So the plants die, we live.

但问题在于，生活在我们大肠里的微生物并没有这种能力。

But there's a problem, which is that the microbes that live inside of our large intestine, they don't have the workaround.

你可能会想，这点微量的草甘膦对咱们这么大的人来说，根本算不了什么。

So that microscopic amount of glyphosate, you would say, well, us big humans, that's so small.

那你觉得，当它接触到这些微生物时，会发生什么？

What do you think happens when it comes into contact with them?

我们知道，草甘膦会破坏肠道菌群，杀死有益菌，而那些能耐受它的，恰恰是容易引发炎症的菌种。

We know that glyphosate disrupts the microbiome, that it depletes the beneficial bacteria and the ones that tolerate it the best are the inflammatory ones.

有害的细菌。

The bad bacteria.

有害的细菌。

The bad bacteria.

所以你在改变这种平衡。

So you're shifting the balance.

这看起来是件小事，但我听不少人说过，史蒂夫，他们在美國吃小麦就出问题。

And this is a small thing, but I hear from people, Steve, that go to Italy, they say, I can't eat wheat in The United States.

可一到意大利，他们就没事了。

And then they go to Italy and they're fine.

你觉得是草甘膦的原因吗？

And you think it's that glyphosate?

是的。

Yeah.

他们在那儿不喷这个。

They don't do that there.

那我今晚试试有机意大利面，也许会好一些。

So if I tried I'll try organic pasta tonight and maybe that will be better.

对。

Yes.

那其他选择呢？你是怎么吃面包的？

And then like the alternative choice is how do you do with bread?

你吃这个没问题吗？

Are you okay?

不是所有的面包我都吃。

Not all bread.

一般来说，我都尽量避开。

My my generally, I stay away

避开面包。

from bread.

明白了。

Okay.

你吃过酸面包吗？

Do you ever eat sourdough?

是的。

Yeah.

你吃酸面团面包没问题吗？

Do you do okay with sourdough?

是的。

Yeah.

这就对了。

There we go.

接下来是这个问题的第二部分。

So here's the second part of this equation.

先把草甘膦放一边，先不谈它。

Put the glyphosate, put that to the side for a moment.

咱们回头说说刚才提到的果聚糖。

Let's talk about the fructans that we were talking about a moment ago.

如果你发酵小麦面团，果聚糖的含量其实会降低。

When you ferment your wheat, when you ferment your dough, you actually reduce the fructan content.

果聚糖是什么？

What's fructan?

这些是存在于小麦、大麦和黑麦中的长链碳水化合物。

So these are the long chain carbohydrates that exist in wheat, barley, rye.

所以只要含有麸质，就也会有这些果聚糖。

So if it contains gluten, it also contains these fructans.

小麦里不止有麸质，这些果聚糖其实对身体有益。

Gluten is not the only thing in wheat, And these fructans, again, they're good for you.

它们对肠道菌群有好处。

They're good for your microbiome.

但那些肠道有点受损的人，消化起来就比较吃力。

But people who have a slightly damaged gut, they struggle to process and digest them.

这就解释了为什么有些人吃了含麸质的食物会不舒服。

So this would explain why some people, eat wheat containing, gluten containing foods and they struggle.

但他们吃发酵面包却没问题，因为发酵过程能降低果聚糖含量，这样就更容易耐受了。

But they do okay with sourdough because if you ferment the bread, reduces the fructan content and actually then you can tolerate it.

哦，原来如此。

Oh, okay.

所以你觉得我有问题的可能是面包里的低聚果糖，而酸面包里没有这种成分？

So you think it might be the fructane in the bread that I have an issue with and sourdough doesn't have fructane in it?

对。

Yeah.

几年前有一项研究发表在《胃肠病学》上。

There was there was a study that was in gastroenterology a few years ago.

《胃肠病学》是我领域里最顶尖的期刊，他们当时让受试者带一些早餐棒回家。

Gastroenterology is the top journal in my field where basically they they send people home with a bunch of breakfast bars.

好吧，不是巧克力口味的，但意思差不多。

All right, not chocolate but nonetheless.

他们让受试者带了三根早餐棒回家。

They sent people home with a bunch of breakfast bars, three of them.

其中一根是安慰剂，什么都没加。

One of them was a placebo bar, so they didn't add anything special.

另一根含有非常高剂量的麸质。

One of them contains a very large concentration of gluten.

第三种则含有果聚糖。

And then the third one contains the fructans.

安慰剂是我们对照的标准。

And the placebo is our standard.

我们要拿它来做对比。

We're going to compare to that.

当人们吃了含麸质的能量棒时——顺便说一下，这些人并没有乳糜泻，但他们自己觉得有麸质不耐受，对吧？

When people ate the gluten containing bar, and these were by the way people that, they did not have celiac disease, they did have gluten problems according to them, right?

这其实就是你刚才提到的那百分之二十自认为有麸质问题的人。

So this is like the twenty percent of people that you mentioned a moment ago who think they might have a gluten problem.

结果发现，他们吃含麸质的能量棒时，症状反而比吃安慰剂还轻。

When they ate the gluten containing bar, they actually had less symptoms than the placebo.

也就是说，麸质根本不是问题所在。

So in other words, the gluten is not the problem.

但当他们吃了含果聚糖的能量棒后，症状就出现了。

But when they ate the fructan containing bar, they were triggered.

所以，这实际上说明，我们一直以来对‘麸质不耐受’这个说法理解错了。

So basically what this said is that we have been taking this concept of gluten intolerance and we've misnamed it.

根本不是什么麸质不耐受。

It's not a gluten intolerance.

真正的问题是果聚糖不耐受。

It's a fructane intolerance.

这些人其实是对这类食物中的特定成分比较敏感。

These are people who are tending to struggle with these particular parts of that food.

哪些食物含有果聚糖呢？

What foods contain fructane?

小麦、大麦和黑麦。

Wheat, barley, and rye.

明白了。

Okay.

顺便说一下，果聚糖其实有很多种。

And there's many different types of fructans, by the way.

所以你可能不是对所有这些都敏感，也许只对其中一部分有反应。

So you may not react to all of them, You may react to just some of them.

但大蒜和洋葱也是典型的例子。

But garlic and onions are also classic.

你常听到有人说：我不能吃大蒜。

So you hear people who are like, I can't eat garlic.

吃了感觉特别不舒服，对吧？

I feel horrible, right?

这可能是果聚糖的问题。

That can be a fruit tan issue.

藜麦、苋菜、高粱、苔麸，这些全谷物不含麸质，也不含果聚糖。

Teff, amaranth, sorghum, quinoa, these are whole grains that don't contain gluten and they also don't contain fructans.

如果肠道已经受损，修复需要多长时间？

How long does it take to repair the gut when you have done damage to it?

这个问题故意问得比较宽泛。

That's a very broad question intentionally.

但一般来说，对于普通人的肠道受到刺激的情况，要多久才能恢复，那些微生物才能恢复正常呢？

But generally, for the average person who's done has sort of irritated their gut, how long does it take to restore and for those microbes to go back?

这得看情况。

It really depends.

首先得弄清楚，你的起点是什么？

You have to start with, okay, what's your starting point, right?

比如，损伤有多严重？

Like how deep is the damage?

情况有多糟？

How bad is it?

因为像溃疡性结肠炎或者克罗恩病这类患者，他们的肠道菌群失衡是最严重的。

Because for the people who have ulcerative colitis or Crohn's disease, those are forms of inflammatory bowel disease.

这些人肠道菌群失调的程度是最深的。

Those people have the deepest dysbiosis.

我们用‘菌群失调’这个词来形容肠道受损的状态。

Dysbiosis is the word that we use for a damaged gut.

这种情况能逆转吗？

Is it possible to reverse that?

可以让病情进入深度缓解，完全不再发作。

It's possible to put them into remission so deeply that they don't have a flare.

我面前这个模型上显示的，就是发作时的样子吗？

Is that what the flare looks like on this little model that I have in front of me?

是的。

Yes.

回到刚才的话题，对那些正在听但没在YouTube上的人，如果你感兴趣，可以切换到YouTube，我这里展示的是结肠的模型。

So going back, for the people who are listening and not on YouTube, you can flip over to YouTube if you're interested, but what I'm showing here is the model of the large intestine.

模型上有一小块区域看起来发红、溃烂，还在出血。

And the model includes a little area that it looks raw, ulcerated, it's bleeding.

如果你碰一下那里，马上就能看到出血。

If you were to bump up against it, it's going to start to you'll start to see blood coming out.

所以这是一个非常脆弱、敏感的区域。

So it's like a it's a very vulnerable sensitive area.

现在，关于炎症性肠病，史蒂夫，我有个挺有意思的研究想跟你分享。

Now, inflammatory bowel diseases, Steve, I have an interesting study on this topic.

在我看来，这绝对是肠道炎症类疾病的典型代表。

They are to me the classic gut inflammatory health condition.

实际情况是，免疫系统在攻击肠道菌群。

And what's happening is the immune system is attacking the microbiome.

严格来说，这不算自身免疫病，因为自身免疫是身体攻击自己的组织。

So technically it's not actually autoimmune because autoimmune would be you're attacking your own body.

免疫系统并没有攻击你的肠道。

The immune system is not attacking your intestines.

它攻击的是你的肠道菌群，把你体内的菌群当成了外敌。

The immune system is attacking your microbiome and rejecting it.

正因如此，你的肠道就被夹在中间，进退两难。

And because that's happening, your intestines are stuck in the middle.

所以，这里就是免疫系统在攻击肠道菌群？

So this here is the immune system attacking the microbiome?

它攻击的是大肠里的微生物群，免疫系统想把它们找出来并消灭掉。

It's attacking the microbiome, which is in the tube of the large intestine, and the immune system is trying to get at it and kill it.

为什么呢？

Why?

因为免疫系统把它们当成了敌人。

And because it's decided that it's the enemy.

所以免疫系统其实搞混了，因为人刚出生的时候，体内几乎没有微生物群。

So the immune system is confused because when we're born, we don't have much of a microbiome at birth.

这大概是人体最接近‘什么都没有’的状态了。

It's the closest that we will get to not really having anything.

但在出生后的头三年，你会通过生活经历逐渐建立起自己的微生物群。

And then during the first three years of life, you build your microbiome through your life experience.

到三岁左右，你的微生物群就已经基本发育到成人的规模了。

And by three years of age, you are basically fully adult sized in terms of your microbiome.

在这段时间里，你的免疫系统一直在跟这些微生物互动、学习。

During this time, your immune system is learning from and with those microbes.

所以这两者之间存在着一种无法忽视的互动：如果孩子在出生后的头三年里，肠道菌群健康，免疫系统也会更健康。

So there's this interplay between the two that is undeniable where when the microbiome is healthy during childhood, during those first three years, it results in a healthier immune system.

那这背后到底发生了什么？

So what's going on here?

免疫系统本该认出肠道菌群是友好的，但它没有。

The immune system is supposed to acknowledge your microbiome as being friendly and it does not.

它反而把肠道菌群当成敌人，开始攻击它们。

It decides that your microbiome is the enemy and so it's taking it out.

那对于患有肠易激综合征或者克罗恩病的人，他们的肠道里有严重的溃疡，这通常是因为生活方式造成的吗？

So what do you think is, for someone that has irritable bowel syndrome or Crohn's disease, they have one of these big ulcers in their small or large intestine, is it because of their lifestyle, typically?

是生活方式的问题，还是多种因素共同作用的结果？

Lifestyle change or is it lots of things?

最主要的元凶是什么？

What's the number one perpetrator?

好吧。

Okay.

这显然有遗传因素。

There's clearly a genetic component.

对。

Okay.

所以我们得坦率地承认这一点。

So we have to be upfront about that.

这些情况并不是一个人完全能掌控的。

Like, these are things that are not necessarily within a person's control entirely.

因为从进化角度看，这种情况根本说不通。

Because, I mean, there's no evolutionary reason why this would happen.

根本没什么进化上的好处，会让人出现严重的肠胃消化问题。

Like, there's no evolutionary reason why you'd have severe gut digestion problems.

没错。

No.

这没什么好处，而且这类问题在几十年前可罕见多了。

It's not to there's no advantage to it at And and these things that that occur, they were quite rare years ago.

事实上，如今在发展中国家，炎症性肠病的情况并不多见。

In fact, in third world countries today, there's not much inflammatory bowel disease.

在发展中国家，克罗恩病和溃疡性结肠炎的发病率也很低。

There's not a lot of Crohn's disease and ulcerative colitis in third world countries.

如果你去非洲，几乎看不到什么病例。

If you go to Africa, there's very little.

但随着国家工业化，这些疾病的发病率就开始迅速上升。

And then what you see though is as countries industrialize, there's a takeoff and they start ramping up.

在美国，从1970年到2010年的四十年间，溃疡性结肠炎和克罗恩病的病例增长了高达百分之五十五。

So within The United States, over the course of forty years from 1970 to 2010, ulcerative colitis and Crohn's disease cases were increasing by up to fifty five percent.

这种病在任何年龄都可能发病吗？

And you can get that at any age?

是的，任何年龄都可能发病。

You can get that at any age.

所以，即使我现在很健康，也可能因为某些行为最终患上这种病？

So even if I'm healthy right now, I could do a set of things that would give me this?

对。

Yes.

其实，这就回到我们之前聊到的抗生素话题了。

In fact, if you take So back to our conversation about antibiotics.

如果你吃了抗生素，接下来一年内患上炎症性肠病的风险会直接翻倍。

If you take antibiotics, your risk of developing an inflammatory bowel disease in the next year just doubled.

天哪。

Oh gosh.

如果你用抗生素扰乱肠道，而抗生素确实会这样做，那么基本上没有什么比这更能迅速摧毁肠道了。它会减少肠道多样性，在服用抗生素期间使肠道屏障受损达50%，并激活免疫系统。

If you disrupt the gut with antibiotics, which the antibiotics do, there's nothing that will basically decimate the gut faster, reducing gut diversity, disrupting the gut barrier by 50% during a course of antibiotics, and activating the immune system.

这充分说明，如果你服用抗生素，那些与炎症相关的健康风险真的会开始上升。

It really speaks to that, like if you take antibiotics, these risks of inflammatory health conditions really start to go up.

我们在成年人和

We see this in both adults and

病例中都看到了这一点。

episode.

如果你想听完整这一期，我下面放了链接。

If you want to listen to that full episode, I've linked it down below.

详情里有。

Check the description.

谢谢。

Thank you.