肠道健康一期：哈佛医生揭秘什么是正常（以及什么是不正常的）

我的意思是，相信这一点既激进又令人惊叹。

I mean, that's a both radical and a crazy amazing thing to believe.

我的意思是，我认为这是真的。

I mean, I think it's true.

我确实这么认为。

I really do.

这不仅仅是信念。

It's more than a belief.

我的意思是，谢天谢地。

I mean, thank god.

到目前为止，我们已经有了数十年的数据，证明这是正确的。

At this point, we have decades now of data that showing that this is true.

我认为这是一件非常了不起的事情，因为它意味着我们还有其他方法可以治疗这些症状，真正去应对这些状况，从而改善生活。

Well, I think it's like something that's super amazing to consider because that means there are other ways that you can treat those symptoms or really go after those conditions and feel better in your life.

是的。

Yeah.

说得完全正确。

That's exactly right.

我的意思是，如果你一生都被告诉，你的肠道症状是由压力、焦虑或抑郁引起的。

I mean, if your whole life, you've been told that your gut symptoms are due to stress, they're due to your anxiety, they're due to your depression

是的。

Yes.

那么你只能依赖一套针对大脑的工具、药物和治疗方法。

Then you're left only with this set of tools and medications and treatments that are gonna address the brain in your head.

你只有这些。

That's all you have.

因此，你可能会服用抗抑郁药、抗焦虑药。

So you're gonna be taking things like antidepressants, antianxiety medicines.

也许你会接受认知行为疗法。

Maybe you'll do cognitive behavioral therapy.

所有这些方法都很重要，在治疗这些疾病中都占有重要地位。

All of these tools are important, and they have a really important place in treatment of these disorders.

然而，一旦你意识到肠道可能是问题的根源，这就打开了一扇门，让你能够使用另一整套主要针对肠道、以打断这种恶性循环的治疗方法。

However, once you realize that the gut can be the source of the problem, it opens this door to this whole other toolkit of treatments that will primarily target the gut to interrupt that vicious cycle.

所以这又给了你更多的选择。

So it gives you options back.

即使肠道不是根本原因，它也肯定加剧了症状的严重程度。

And even if it's not the actual source, it certainly is contributing to the extent to which the symptoms feel even worse.

没错。

Absolutely.

我的意思是，我们并不认为肠脑连接只是大脑对肠道的单向影响，或者肠道对大脑的单向影响。

I mean, we don't think of the gut brain connection as just the brain talking to the gut or just the gut talking to the brain.

我们见过太多次了，这其实是一个恶性循环。

We have seen so many times it's a vicious cycle.

对吧？

Right?

比如，如果你每天都饱受严重的肠道症状困扰，这可能会引发焦虑，而焦虑又会加重肠道症状，反之亦然。

Like, if you have horrible gut symptoms as many people are living with every day, that can give you anxiety, and then the anxiety can fuel the gut symptoms and vice versa.

而且，有时仅仅从大脑和头部层面进行干预并不能阻止这些症状。

And it's not sometimes just intervening at the level of the brain and the head that can stop them.

有时你需要从源头上制止问题，关掉水龙头，这就需要关注肠道。

Sometimes you need to stop the upstream source and shut off the faucet, and that's looking at the gut.

我喜欢这一点的是，如果你是一个深受焦虑困扰的人，或者总是反复思考、头脑中思绪纷乱，或者现在感到极度抑郁，想要去面对和对抗这些想法，会感觉不堪重负。

Well, what I love about this is that if you're somebody that really struggles with anxiety or you're a ruminator and you're constantly up in your head or you're feeling extremely depressed right now, going up in your head and wrestling your thoughts feels like an overwhelming thing to do.

知道我们将向你们介绍一些经过临床和科研验证的、有助于缓解这些症状的肠道养护方法，这太棒了。

Knowing that you're gonna talk to us about ways we can take better care of our gut that are clinically and research backed in terms of helping alleviate those symptoms, that's amazing.

所以从医学角度来看，当我提到‘我有直觉’，是的。

So from a medical standpoint, when I say I have a gut feeling Yeah.

或者‘我胃里有蝴蝶在飞’，这到底意味着什么？

Or I've got butterflies in my stomach, what does that mean?

这背后的科学原理是什么？

Like, what's the science behind that?

是的。

Yeah.

这些是真实的生理反应。

Those are that's real physiology.

这不仅仅是比喻。

Those aren't just metaphors.

压力、恐惧、兴奋，这些都会触发我们的杏仁核。

So stress, fear, excitement, these can all trigger our amygdala.

杏仁核是大脑中一个重要的情绪处理中心。

That's a certain part of the brain that's an important emotional processing hub.

它会促使杏仁核向大脑的另一部分发出信号，释放一种名为促肾上腺皮质激素释放激素（CRH）的激素。

It causes the amygdala to signal to another part of the brain to release a hormone called corticotropin releasing hormone or CRH.

CRH具有两种作用。

CRH is two things.

它会作用于胃，使其减缓运作，然后向下影响结肠，使其加速蠕动。

It acts on the stomach to slow it down, and then it moves down to the colon, and it speeds it up.

所以当我们第一次约会时，可能会感到胃里有蝴蝶飞舞，或者在要做演讲前突然急着上厕所——为什么会这样呢？

So that's why when we are on a first date, we might feel butterflies in our stomach or when we have to give a presentation, like, right before we suddenly have to go to the bathroom Why does that happen?

现在。

Right now.

对吧？

Right?

为什么会这样？

Why does that happen?

为什么我每次要演讲、或者要进来和你做访谈的时候，总是得去上厕所或者拉肚子？为什么我非得现在去洗手间？

Why do I always have to pee or go number two right before I'm about to give a speech or I'm about to or I'm about to walk in here and do an interview with you, which, like, why do I have to go to the bathroom right now?

是的。

Yeah.

在我职业生涯早期，我发现了这一现象发生的一种机制。

Well, early in my career, I discovered one of the mechanisms by which this happened.

所以我用了一种叫做胃电图的仪器。

So what I did was I used a machine called an electrogastrogram.

这和用来测量心率的心电图非常相似。

That's no it's very similar to an EKG, which people use to measure the heart rate.

是的

Yep.

对吧？

Right?

心脏以每分钟60次左右的规律节律跳动。

And so the heart beats at this regular rhythm of 60 beats per minute or so.

结果发现，你的胃其实也有自己的节律，以大约每分钟3次的频率有规律地收缩。

Well, it turns out your stomach is actually has its own rhythm, and it's contracting at a regular rate of about three beats per minute.

但我发现，当你撒谎时，这种每分钟3次的规律节律就会陷入完全混乱。

But what I found is that when you're telling a lie, that regular rhythm of three beats per minute, it goes into total chaos.

它不再以每分钟3次的频率收缩。

It doesn't contract anymore at three beats per minute.

它会进入一种称为心律失常的混乱节律，没有任何可辨别的模式。

It enters this chaotic rhythm called arrhythmia where there's no discernible pattern.

结果发现，这个你实际上可以用胃来作为测谎仪的发现，让我获得了一颗以我名字命名的小行星。

And it turns out that that discovery where you could actually potentially use your stomach as a lie detector, it got an asteroid named after me.

但更重要的是，它让我对肠道和大脑有了一个深刻的领悟：

But more importantly, it taught me something really profound about the gut and the brain, which is this.

肠道对来自外界的信息的反应速度，常常远超你意识大脑的处理能力。

The gut can respond to external information often so much quicker than your conscious brain can process.

有些人称之为直觉，但关于直觉，我们常常误解了什么。

And some people call that a gut feeling, but here's what we get wrong about gut feelings.

我们通常会把直觉简单地归类为好或坏。

We often assign gut feelings we label them as being good or bad inherently.

而直觉本身既不是好，也不是坏。

And a gut feeling is neither good or bad.

它是一种科学现象。

It's a scientific phenomena.

它是一种生理信号，仅仅是一个信息。

It's a physiological signal, and it's simply a message.

这个信息就是：当前情境的利害关系，比你意识到的要高得多。

And that message is this, the stakes of the situation are higher than you realize.

这就是信息。

That's the message.

它不是好的。

It's not good.

它也不是坏的。

It's not bad.

是我们自己给它贴上了标签，并赋予了它某种预言般的意义，认为它在告诉我什么。

And we are the ones who give it this label and assign it some prophetic value that it's telling me something.

但事实上，我认为如果我们从科学的角度来看，我们所能使用并应该学习的最强大的工具之一就是：不要仅仅冲动地根据我们所谓的直觉行事，而应该学会停下来，倾听这种直觉。

But, actually, I think if we're looking at this just on a scientific level, one of the most powerful tools we can make we can use and something that we should learn is that instead of just impulsively acting on what we're calling a gut feeling, we should learn to pause, listen to that gut feeling.

不要问这是好还是坏，而是问问自己：关于这种情况，我忽略了什么？

And instead of asking, is this good or bad, ask yourself, what am I missing about this situation?

我的直觉感知到了什么，而我头脑中的大脑尚未理解？

What is my gut perceiving that my brain in my head has not yet understood?

让我举两个例子。

Let me give you two examples.

很好。

Great.

假设你是团队中的领导者，有人提出一个新方案，这个方案在纸面上看起来很棒，房间里每个人都点头赞同。

So suppose you're a leader in your group and someone's presenting a new proposal, and that proposal sounds great on paper, and everyone in the room, they're nodding along.

他们喜欢这个方案。

They like it.

你突然感到胃部紧缩。

You suddenly get this tightening in your gut.

流行文化会说，哦，这是直觉。

Popular culture would say, oh, that's a gut feeling.

这是一种不好的直觉。

It's a bad gut feeling.

这个方案有些不对劲。

There's something off about this proposal.

对。

Yes.

你应该拒绝它。

You should reject it.

对。

Yes.

也许这个提案真的很糟糕。

And maybe the proposal is horrible.

我不确定。

I'm not sure.

但我认为现在就下定论为时过早。

But I think it would be premature to say that.

你应该思考并考虑：如果你的直觉反应的不是某种固有的风险，而是新奇性呢？

What you should wonder and consider is what if you're getting a gut feeling that's responding not to some inherent risk, but to novelty?

如果这个提案以一种你从未经历过的方式挑战了你的思维方式呢？

What if this proposal is challenging your way of thinking in a way you've never done before?

也许这是一件好事。

Maybe that's a wonderful thing.

我喜欢这个观点：每当你产生直觉时，不要立刻想，哦，有直觉了。

I love this idea that that whenever you get a gut feeling, don't immediately go, oh, there's a gut feeling.

不管是好是坏。

Good or bad.

我听到你说的是，当你产生直觉时，就像叮叮叮。

What I'm hearing you say is when you get a gut feeling, it's like ding ding ding.

要引起注意。

Pay attention.

没错。

That's right.

这说明有件事我需要留意。

There's something that I need to pay attention to.

第二个例子是什么？

What's the second example?

假设我们正在约会。

Well, suppose we're on a date.

是的。

Yes.

你遇到了这个新男人。

And you've met this new man.

顺便说一下，这次约会你穿得真不错。

Love what you're wearing, by the way, on this date.

我很欣赏你。

I appreciate you.

我 already 她穿着

I'm already She's wearing

约会已经进行得很顺利了，所以

Date is already going cool so

西装。

suit.

她看起来太棒了。

She looks amazing.

好的。

Okay.

谢谢。

Thank you.

所以这次约会显然进行得很顺利。

So date is obviously going well.

他们一直在夸你。

Very They're complimenting you.

是的。

Yes.

而且对话也很顺畅。

And the conversation's going fine.

然后也许约会中会出现这样一个时刻：你的手伸出去，他们的手也伸出来，指尖轻轻触碰。

And then maybe suppose that moment in the date comes where, like, your hand reaches out, their hand reaches out, fingers touch fingers.

一阵酥麻。

Tingling.

是的。

Yep.

但什么也没发生。

Except nothing happens.

假设你们碰到了，然后就结束了。

Suppose you touch each other, and that's it.

你没有心跳加速的感觉。

You don't get butterflies.

别有心跳加速的感觉。

Don't get butterflies.

对。

Yeah.

现在，当然，事情来了。

Now, of course, here we go.

通俗科学跳出来就说，哦，没电火花。

Pop science jumps in and says, oh, there's no spark.

没有化学反应。

There's no chemistry.

他不是那个对的人。

He's not the guy.

她不是那个对的女生。

She's not the girl.

你可能会非常重视这种直觉的缺失，并说：你知道吗？

And you might assign a lot of value to that absence of a gut feeling and say, you know what?

那种火花，根本就不存在。

The spark, it just wasn't there.

不值得。

I it's not worth it.

我觉得很多人都会这样想。

I think a lot of people do.

完全对。

Totally.

我想提醒你的是，生理反应，你的直觉并不是在预示未来。

And what I'd like to remind you is that the physiology again, your gut is not telling the future.

当你有这种感觉或没有这种感觉时，这本身并不是好事或坏事。

It is not a good or bad thing when you have that feeling or when you don't have that feeling.

因为也许在那一刻发生的情况只是你感到安全，感到完全平静？

Because what if what is happening in that moment is simply that you feel safe, that you feel completely regulated?

这难道不是一件很棒的事吗？

Is that not a wonderful thing?

而且也许是对的。

And maybe right.

比如，也许这个男人真的不适合你。

Like, maybe this guy is not the right guy for you.

我不能说你的直觉没有在告诉你这一点。

I can't tell you that your gut is not telling you that.

它只是在建议你再约一次，多收集一些信息，看看他是不是对的人，而他可能依然不是。

It's asking you to maybe go on one more date, maybe gather more information, and see if he's the right guy, and he may still not be.

实际上，有很多研究围绕着所谓的‘慢热型关系’，这种关系一开始并没有太多火花，但你和对方相处的时间越长，就越会意识到，那种平静和安然自在的状态才是真正美好的东西。

There's actually a lot of research around what they call the slow burn relationship where there's not a ton of sparks in the beginning, but the more time you spend with somebody, the more you realize it's the calmness and this state of just being okay that is really the beautiful thing.

而我们很多人却急于追求那种兴奋感，并把它当作好事。

And a lot of us race towards that, like, excitement thing and read it as a good thing.

也许很多时候，这种兴奋感其实是你的身体在说：哦，这又像那六个甩了你的前任一样。

And maybe a lot of the excitement, thing sometimes is actually your body going, oh, this is just like the other six people that ghosted you.

请别依赖这种感觉。

Please don't lean

去依赖它。

into this.

是的。

Yeah.

你并不知道。

And you don't know.

这个人可能会不一样。

This person could be different.

因为请记住，你的直觉并不是想替你编故事。

Because just remember, your gut, it's not trying to write the story for you.

它只是在提醒你要更仔细地阅读自己的故事。

It's simply asking you to read your own story more closely.

我喜欢这个说法。

I love that.

所以不要再说了，我有直觉，我要这么做。

So no more, I got a gut feeling, I'm doing it.

而是要说：我有直觉，哦，我得留意了。

It's I got a gut feeling, oh, I gotta pay attention.

是的。

Yep.

根据正在发生的事情，我该做吗？

And based on what's happening, do I do it?

还是不该做？

Do I not?

砰。

Boom.

收集更多信息。

Gather more information.

不要冲动行事。

Don't act impulsively.

稍作停顿。

Just take a beat.

既然我们谈到了直觉，有多少人对直觉有困扰？

Now that we've talked about the gut, how many people have issues with the gut?

比如，这有多普遍？

Like, how widespread is it?

你能列举一些人们在直觉方面常遇到的问题吗？

And can you list off some of the common things that people can struggle with when it comes to the gut?

是的。

Yeah.

这里有一个数字让我意识到，我们正面临着一个显而易见的肠道健康危机——百分之四十。

Well, here's a number that made me realize that we have a gut health crisis hiding in plain sight, forty percent.

百分之四十？

Forty percent?

百分之四十的美国人表示，他们的肠道问题干扰了日常生活。

Forty percent of Americans say that their bowels disrupt their daily lives.

百分之四十。

Forty percent.

这意味着我们每个人都认识某个人，爱着某个人。

So that means all of us know somebody, love somebody.

也许我们自己就是每天都在应对这个问题的人。

Maybe we are somebody who's dealing with this every single day.

而这还只是冰山一角。

And that's just the tip of the iceberg.

百分之十五的美国人患有肠易激综合征。

Fifteen percent of Americans have irritable bowel syndrome.

四分之三的美国人无法在公共厕所排便。

Three out of four Americans can't poop in a public restroom.

三分之一的人在度假时难以如厕。

One out of three struggle to go to the bathroom on vacation.

十分之一的人每次进食时都会经历慢性不明原因的疼痛。

One out of ten live with chronic unexplained pain every time they eat.

十分之一。

One out of ten.

孩子们的情况也不容乐观。

And the kids are also not alright.

在我的实验室中，我们发现大学生中约有四分之一每次如厕时都要花十分钟以上才能排便。

In my own lab, we found that college students about a quarter of college students spend more than ten minutes at a time trying to have a bowel movement every time they go.

这里最令人惊讶的是，大多数人并不会认为自己生病了。

And the crazy thing here is that most of these people would not identify as being sick.

他们未必会觉得自己有问题。

They wouldn't think necessarily that they have a problem.

他们几乎把所有这些症状都当作正常了，而这正是整个问题所在。

They kinda would have normalized all these symptoms, and that is the entire problem.

问题在于，我们对肠道健康的讨论还不够大声，也没有正视我们每个人正在经历的一切。

The problem is that we are not having a loud enough conversation about our gut health and acknowledging what all of us are going through.

我认为部分原因在于，我们关于排便的知识大多来自父母在我们幼儿如厕训练时教给我们的东西。

And I think part of that is due to the fact that most of what we learn about having a bowel movement comes from what our parents taught us when we were toddlers potty training.

他们教我们的内容，和你们祖父母教他们的方式几乎一模一样。

And what they taught us is pretty similar to what your grandparents taught them.

在某个时刻，我们必须问自己：祖母的方法真的能100%完美吗？

And at some point, we have to ask ourselves, can it really be true that grandma's method was a 100% flawless?

难道科学就再也无法教给我们更多关于如何改善排便的方法了吗？

Like, there's nothing else the science can teach us about how to have a better bowel movement.

在我完成培训后不久开设胃肠科诊所时，许多成年患者最常问我的一个问题就是：我的排便正常吗？

And when I started my GI clinic soon after I was done training, one of the most common questions that fully grown adults would ask me was just this, Are my bowel movements normal?

如果连成年人都在问这个问题，那就说明我们一直都在瞎碰乱撞，而且每个人都以为别人掌控得很好，但数据显然告诉我们并非如此。

And if that's the question that we're all asking as adults, it taught me that we've just been winging it for way too long, and we all think everybody else has it under control, but clearly the data shows us otherwise.

好的。

Okay.

我想再深入探讨一下这一点。

I wanna just dig in there just a little bit.

请说。

Please.

医生帕什里卡，关于肠道健康以及从口腔到排泄口整个系统的功能——包括水分吸收、营养摄取、免疫力、荷尔蒙生成，甚至影响情绪的这些不可思议的机制——您希望我们从医学角度如何理解自己的排便情况呢？

Because how do you want us, doctor Pasricha, when it comes to gut health and the whole system from your mouth all the way to the exit and all of the important functions that happen there from hydration to nutrients to immunity to hormone creation, impacts your mood, to all this unbelievable stuff that is happening in the gut, how do you want us, like, medically speaking, to actually think about our bowel movements?

到底什么是正常的呢？

What what is it?

因为我觉得这可能信息量太大了，但每个人都会排便，而且你必须转身去冲马桶。

Like, because I think because I'll just be this might be too too much information, but, you know, every one of us has a bowel movement and you have to turn around to flush the toilet.

我知道我不只是唯一一个会低头看马桶里情况的人，但我不知道自己该找什么，也不知道该如何解读那些可能透露出重要信息的线索。

And I know I'm not the only person that looks down to see what's happening down there, but I don't know what I'm looking for, and I don't know how to even think about the information that could be there to tell me something.

现在大家都在做各种大型检测来评估整体健康和长寿，都得把粪便收集到皿里取样，是这样吗？

Does that mean because now all the big tests that everybody's doing to figure out your full longevity and all this stuff, gotta poop in a dish and scoop it out and all.

所以我们正在对此进行检测，但我很高兴我们讨论了这个问题，因为我觉得这些数字令人震惊。

So we're testing it, but I'm glad we're talking about this because I think those numbers are jaw dropping.

百分之四十的人确实如此。

Forty percent of people Yeah.

正在经历这种情况。

Are dealing with this.

百分之十五的人患有肠易激综合征。

Fifteen percent of people have IBS.

四个人中有三个人无法在公共厕所排便。

Three out of four people cannot go number two in a public bathroom.

是的。

Yeah.

事实上，今天早上我和几位同事聊天，他们都承认自己在工作中不会排便。

In fact, I was having a conversation this morning with a couple colleagues, both of whom admitted they don't go number two at work.

对。

Yeah.

我们在工作，一天八到十二个小时，对吧？

And we're at work, what, eight, twelve hours a day?

我的意思是，想想看

I mean, think about how

现在，我认为大多数人都觉得这是心理问题，但我不确定，也许并不是。

Now is I I and I think most of us think it's psychological, but I don't maybe it's not.

我觉得很荒谬，每三个人中就有一个在度假或旅行时无法上厕所，而那时你本该放松的。

And I I think it's insane that one out of three people can't go the bathroom when they're on vacation or traveling when you're supposed to be relaxed.

我知道很多人就是这样，他们旅行时，已经七天没排便了。

I know lots of people like that who will literally be traveling, and it's it's been seven days since I've gone number two.

百分之百。

100%.

是的。

Yeah.

好的。

K.

那我们来谈谈，这到底是什么数据？

So let's talk about the like, what is is it data?

也就是说，为什么在肠道健康方面这很重要？

Like, how how how why is this important when it comes to gut health?

是的。

Yeah.

你说得非常对。

I think you're spot on.

我认为你不需要那些第三方检测，它们声称能分析你粪便中的各种成分，其实你只需要回头看看就行。

I don't think you need a lot of these third party tests that will claim to look at all these different things in your stool when you just need to turn around and take a look.

因为每次上厕所，都像是收到一份关于你健康的小小成绩单。

Because every time you go to the bathroom, it's kinda like getting a little report card on your health.

所以你可以通过观察和了解自己的排便情况，获得大量信息。

And so you can take a look and learn so much information just by what you're seeing and what you know about that bowel movement.

明白吗？

Alright?

所以我很高兴你注意到了，梅尔。

So I'm glad that you look, Mel.

好的。

Okay.

当我问我的病人：你的大便看起来怎么样？时，我觉得特别奇怪。

I find it so odd when I ask my patients, well, what did your poop look like?

他们却说：我没看。

And they say, well, I don't I don't look.

我觉得他们在撒谎。

I think they're lying.

甚至对你这位医生也在撒谎。

Even to you as the doctor.

那我们到底是为了什么而在这里呢？

Like, what are we here for then?

你知道的。

You know?

所以，你真的得看一下。

And so, like, you have to look.

当你观察时，我要你注意这些方面。

When you look, here's what I want you to be on the lookout for.

形状。

The shape.

粪便的质地能告诉你很多关于它在结肠中移动速度的信息。

The consistency of the stool gives you a lot of information about how quickly that stool has been able to move through your colon.

好的。

Okay.

颜色我们会详细讲，这能提供大量信息。

The color we're gonna get into, that gives you a lot of information.

你的感受，记下来。

How you felt, make note of that.

你排便时感觉怎么样？

How did you feel when you had a bowel movement?

你感到疼痛了吗？

Were you in pain?

你排便时感到不适吗？

Were you uncomfortable when you had a bowel movement?

排便后你感觉好些了吗？

Did you feel better after you had one?

排便间隔期间你有腹胀感吗？

Did you feel bloated in between?

你可以从粪便的外观、你的感受中收集大量信息，然后利用这些信息做出一些调整。

You can gather lots of different information from what it looks like, how you felt, and then you can use that information to make some changes.

你想对那些患有慢性便秘、却对排便问题避而不谈的人说些什么呢？毕竟我们都没人接受过如何正确排便的训练。

What do you wanna say to somebody who has chronic constipation and they're a clencher about the reality of that this might because none of us have been trained to poop.

如果你仔细想想，我突然作为一名母亲感到内疚，因为我想到那些你更换的尿布——是的。

If you really think about it, one of the things I was thinking about is I've all of a sudden felt bad as a mom because I'm thinking about those diapers that you change Yeah.

当你可爱的宝宝在那里，你看着尿布，心想：天啊，这是什么？

Where your sweet little baby's there and you're like, oh, what is this?

天啊，这真是这样。

This is like, oh my gosh.

芥末色的大便感觉太糟糕了。

Mustard poop has felt terrible.

所以我们对它的反应，是的。

And so our reaction to it Yes.

这也造成了对如此正常的事情的尴尬和羞耻感。

Also creates this, like, embarrassment and shame around something that's so normal.

我很高兴你这么说。

I'm so glad you said that.

从第一天起，我们就把身体、把排便当成一个邪恶的东西。

I from day one, we treat our bodies, our bowel movements as this nefarious entity.

太让人尴尬了。

Like, it's so embarrassing.

太恶心了。

It's so yucky.

太恶心了。

It's so icky.

你不该拉便便，因为这太糟糕了。

You shouldn't make poop Jill because it's so horrible.

我们从小就被内化了这种观念。

And and we internalize that from when we're kids.

所以一旦我们完成如厕训练后，就再也没有人关心你是否做得对了。

And so suddenly, after we're done potty training, nobody's checking in on you again to make sure you're doing it right.

对吧？

Right?

比如，我们每年去看几次牙医，他们会说：嘿。

Like, we go to the dentist a couple times a year, and they're like, hey.

你每边刷够两分钟了吗？

Did you do two minutes each side?

记得刷到牙龈。

Make sure you get your gums.

你有清洁到舌头后面吗？

Are you getting the back of your tongue?

在你完成如厕训练后，谁会问你上完厕所关门时都做了些什么？

Who's asking you what you do when you shut the door to have a bowel movement after you're done potty training?

没人会来过问。

Nobody's checking in.

这种情况非常普遍，对吧？我有一些患者是被伴侣强行带过来的。

And it's so common, right, that I have patients who come to my clinic, and it's actually the case that they've been dragged in by their partner.

他们的伴侣会说：每次我说我们要出门，他们就会说：‘再等五分钟’，而你知道，实际上他们要过六十分钟才会出来。

And their partner will be like, every time I say, you know, we need to go somewhere, they'll be like, oh, just five minutes, and they know it's gonna be sixty minutes later that they come out.

我想对你们说的是，如果你一直为此困扰，已经尝试了所有你觉得能试的方法——比如增加纤维摄入、使用MiraLAX等，

And what I wanna say to you is that if you're somebody who has been struggling, you've tried what you feel like is everything, you've tried the fiber, tried, like, the MiraLAX.

你也有锻炼。

You exercise.

你觉得自己已经尽了全力。

You think, you know, you've done what you can.

也许你甚至试过处方药，但还是没用。

Maybe you've even tried a prescription medicine, and it's not working.

想想看，你可能是那三分之一中的一员，这种情况其实很常见。

Consider that you could be in that one in three, which is so common.

那就是百分之三十三。

That's thirty three percent.

嗯哼。

Mhmm.

现在工作室里有我们四个人。

There are four of us in the studio right now.

那应该是四个有便秘问题的人。

Well, it should be four of us with constipation.

四个有便秘的人，是的。

Four of us with constipation then Yes.

我相信是这样。

Well, I'm sure.

我来代表大家说一下。

I'll I'll just speak for all of this.

我们今天都便秘了。

We're all constipated today.

至少我们中有一个人有机械性问题。

At least one of us has a mechanics issue.

完全正确。

Absolutely right.

这太惊人了。

That's incredible.

妙就妙在，与许多其他医疗状况不同，解决方法并不是我得告诉你：恐怕你需要这种药物。

And the beauty of it is unlike a lot of medical conditions where the solution is gonna be, I'm afraid you need this medication.

你得每天服用。

You're gonna have to take it every day.

你可能还需要每天在同一时间服用。

You might need to take it at the same time every day.

这会成为你生活方式的一部分。

It becomes part of your lifestyle.

解决这个问题的一种特定物理疗法叫做生物反馈。

The solution to this is a certain kind of physical therapy called biofeedback.

这种疗法已经得到了验证。

That's the kind of therapy that's been proven.

研究表明，八到十二周内，80%到90%的人会有所改善。

We're talking about eight to twelve weeks is what the studies have shown that eighty to ninety percent of people get better.

如果你想要一个快速解决办法

If you wanna know a quick fix

是的。

Yes.

如果你还不准备接受物理治疗，是的。

If you're not ready for the PT Yes.

一项重要的研究发现，每六个看似患有这种盆底功能障碍的人中，就有一人的问题可以通过在排便时将膝盖抬高至腰部以上来解决，比如使用脚凳、一摞书，甚至一双漂亮的高跟鞋。

What one really important study found is that one out of six people who seem to have pelvic floor dysfunction like this, one out of six, the entire problem could be solved just by raising their knees above their waist when they had a bowel movement using something like a stool, a stack of books, a pair of nice stilettos.

将膝盖抬高到高于

Raise their knees above their

高跟鞋。

stiletto.

我要穿上高跟鞋去上厕所，克里斯。

I'm gonna put my heels on and go go number two, Chris.

这会有帮助的。

It'll help.

是的。

Yes.

说来有趣，每当我们的成年孩子回家时

Well, you know, it's funny you say that because our our every time our our adult kids are home

嗯。

Mhmm.

我走进自己的浴室，垃圾桶就放在马桶正前方，没错。

I walk into my own bathroom, the garbage can is right in front of my toilet Yep.

因为他们把垃圾桶从侧面移到了马桶前，以便把脚抬起来。

Because they have moved it from the side to put it in front to put their feet up.

当然，别再放回去了。

Of course, don't put it back.

但这是因为他们——

But that's because They're

确实如此。

onto actual Yeah.

就是膝盖抬高的这种力学原理。

That actual the mechanics of the knees being up.

所以请你想象一下，再次说明，这是女性解剖结构的横截面。

So I want you to picture so, again, this is the cross section of the female anatomy.

我向你指出的这个部位是直肠。

So what I'm pointing out to you is this is the rectum.

是的。

Yep.

这是结肠的末端。

And this is the end of the colon.

而且它有点弯曲

And it's kinda curved

当它向下延伸时。

as it comes down.

现在想象一下，有一根橡皮筋围绕着这个管道的最后一部分，把它勒紧了。

Now imagine that there's a rubber band around this last part of the tube that is choking it shut.

我们有一块肌肉，叫做耻骨直肠肌，它会勒紧这个部位。

We have a muscle, the puborectalis muscle, that chokes that muscle close.

这是好事。

That's a good thing.

这块肌肉救了我们的屁股。

This muscle saves our butt.

这就是我们不会弄脏裤子的原因。

That's well, that's how we don't poop our pants.

对吧？

Right?

谢谢。

Thank you.

没错。

Exactly.

然而，我们无法在现代马桶上这种90度坐姿中，一边顺利排便，一边放松那块肌肉来让管道打开。

However, we can't have a good bowel movement and relax that muscle so it opens up that tube sitting in this 90 degree chair like position that we have in our modern toilets.

打开这条管道最好的方式就是蹲下。

The best way to open up that tube is to squat.

对吧？

Right?

蹲下是我们几千年前常用的方式，但我们现在改变了这种姿势机制。

And squatting is something that we used to do thousands of years ago, but we've changed those mechanics.

显然，对于很多人来说，蹲下是件困难的事。

And, obviously, squatting is a difficult thing for a lot of people to do.

实际上我并不蹲，但我确实会把膝盖抬高到腰部以上。

And I'm not ask actually, I don't squat, but I do raise my knees above the waist.

你可以用很简单的东西做到这一点，比如

And you can just do that with something as simple as

哦我的天啊。

a Oh my god.

我爱你，我太喜欢这场对话了。

I I I love you, and I'm loving this conversation.

我还有好多问题要问。

There's so many more questions that I have.

我知道你希望我问她很多问题，但让我们先暂停一下，给赞助商一点展示的时间。

I know there's so many questions that you want me to ask her, but let's take a pause to give our sponsors a second to shine.

我想给你一个机会，把这段对话的链接发到你的家庭群聊里，我迫不及待想看看你的朋友群会怎么说。

And I wanna give you a chance to drop the link to this conversation in your family group chat because I can't wait to see what your friend group says.

每个人都会喜欢这个。

Everybody is gonna love this.

别走开。

Don't go anywhere.

我还没开始问那些尴尬的问题呢，你可千万别错过。

I haven't even gotten started with the embarrassing questions, and you don't wanna miss it.

继续关注我们。

Stay with us.

欢迎回来。

Welcome back.

这是你的朋友梅尔·罗宾斯。

It's your friend Mel Robbins.

今天，你和我在这里邀请了哈佛医学院的教授、著名研究员和神经胃肠病学家，帕什里查医生。

Today, you and I are here with professor at the Harvard Medical School and renowned researcher and neurogastroenterologist, Doctor.

特里莎·帕什里查。

Trisha Pasricha.

我们将讨论关于肠道健康你所需要知道的一切。

We're talking about everything you need to know about gut health.

好的。

All right.

医生。

Doctor.

帕什里卡医生，人们通常有哪些症状或抱怨呢？

Pasricha, so what are the symptoms or the things that people complain about?

因为当我们说肠道问题时，尤其是你现在谈到从口腔到肛门的整个消化系统，

Because when we say gut issues, especially now that you're talking about mouth to the rear end

嗯。

Mhmm.

我想听听人们实际来就诊时抱怨的那些你可以视为正常的现象。

I would love to hear what are people coming in and actually complaining about that you can normalize.

然后我们可以谈谈那些绝对不能忽视的症状。

And then we can talk about the symptoms that you should never ignore.

接着我们可以讨论那些只要你还没理解身体在告诉你什么，就一直会经历的症状。

And then we can talk about the symptoms that are simply what you're always gonna experience until you understand what your body's trying to tell you.

是的

Yeah.

人们来我的诊所最常见的抱怨之一是他们难以排便。

One of the most common things that people come to my clinic complaining about is that they struggle to have a bowel movement.

嗯。

Mhmm.

这可能意味着很多不同的情况。

And that can mean a lot of different things.

有些人会说，我每天都会去厕所。

Some people can say, I go to the bathroom every single day.

很好。

Great.

但我要花二十分钟。

But it takes me twenty minutes.

我得用力。

I'm straining.

这很难。

It's hard.

应该花多长时间？

How long should it take?

少于五分钟。

Less than five.

理想情况下，少于一分钟。

Ideally, less than one minute.

好的。

Okay.

这应该是一进一出的事。

It should be an in and out job.

哇。

Wow.

是的。

Yeah.

但如果你每天都有排便，你可能会被告诉，或者你自己认为这让你看起来正常，但对你来说却很不舒服，每次都要花二十到三十分钟。

But if you're having a bowel movement every day, you might be told, you might believe that that makes me normal, but it's uncomfortable for you and you're spending twenty, thirty minutes at a time.

这并不正常。

That's not normal.

人们常常抱怨感到不适、腹胀、疼痛和痉挛，直到能够排便为止。

People complain about having discomfort, bloating, pain, cramps until they're able to have a bowel movement.

而对于一些人来说，排便后这些症状会有所缓解。

And then for some people, the bowel movement helps those symptoms get better.

有时这种缓解只是暂时的，然后症状立刻又回来了。

Sometimes that's only momentarily, and then they come right back.

然后他们又开始积累，直到下一次排便。

And then they're there and they're there and they're building until the next bowel movement.

有些人常常抱怨有强烈的便意。

Sometimes people complain about a lot of urgency.

比如，他们正在工作时突然被便意打断。

Like, they're just interrupted by they're at work.

他们正和朋友在一起，突然间毫无预兆地必须立刻去上厕所。

They're out with friends, and suddenly, out of nowhere, they have to go to the bat and have to do it now.

有很多人，七个人中就有一个。

There are a lot of people, one out of seven people.

好的。

Okay.

我想好好消化一下这个数字。

I wanna just internalize this number.

在美国，每七个人中就有一人经常失禁。

One out of seven people poop their pants regularly in America.

研究结果就是这么显示的。

That's what the studies have shown.

所以当人们发生排便意外时，常常感到孤立、尴尬和羞愧。

So people feel so isolated sometimes and embarrassed and ashamed when they have bowel accidents.

但实际上，这种情况比你想象的更常见，很多人都在默默承受和应对。

It's actually more common than you think, and a lot of people are struggling and dealing with it.

即使在你的船友俱乐部里没人提起，那个房间里也有很多人经历过和你一样的情况。

Even if nobody, like, brings it up at your boat club, a lot of people in that room will have experienced what you're experiencing.

所以有时候人们会谈论这个。

So sometimes people talk about that.

腹胀。

Bloating.

就是单纯的腹胀，这让人非常不舒服。

Just plain old bloating, which is so uncomfortable.

这是一种胀满感，你明明只吃了一点点，却感觉特别饱，还胀气。

It's this feeling of distension that you're too like, you you eat just a little bit, but you feel so full and you feel gassy.

这是一个很大的困扰。

That's a big complaint.

还有一类人，问题不在于排便，而在于进食。

And then there's another group of people who it's not so much having a bowel movement that's a problem, but eating is the problem.

他们觉得吃下的每一样东西都会引起不适，甚至疼痛，可能还有一点恶心，但他们也不确定。

It feels like everything they eat causes them discomfort or even pain, maybe a little nausea, And they're not sure.

他们试过一切方法。

They've tried everything.

他们尝试过排除所有不同类型的食物。

They've tried to eliminate all different kinds of foods.

他们试过各种不同的饮食方式，却始终无法找出原因。

They've gone on all the different kinds of diets, and they can't seem to pinpoint why.

食物到底哪里出了问题，让他们如此困扰？

What is it about food that's giving them trouble?

这些就是会来我诊所的人。

These are the kinds of people who come into my clinic.

当然，如我所说，他们中的许多人有焦虑和抑郁。

And, of course, as I said, a lot of them have anxiety and depression.

确实，很多人的压力加剧了这些问题，让情况变得更糟。

Certainly, lot of them stress fuels these problems and makes them worse.

但很多时候，压力并不是根本问题。

But oftentimes, it's not the stress that's the primary problem.

或者是焦虑或抑郁。

Or the anxiety or the depression.

没错。

Exactly.

问题是你的肠道出了问题，而你却不太清楚该如何应对。

It's that your gut is going haywire, and you're not quite sure how to address it.

接下来你会根据研究和你的临床实践向我们展示一些有助于解决这个问题的方法。

And there are things that you're about to show us based on the research and based on your clinical practice that will help us address it.

哪些肠道症状是你绝不能忽视的，因为它们可能预示着更严重的问题？

What gut symptoms should you never ignore because they signal that something bigger could be happening?

是的。

Yeah.

让我告诉你两个。

Let me tell you about two.

好吗？

Okay?

我想让大家特别注意这一点，因为这真的可能挽救生命。

And this is this is one that I want people to pay attention because I think this could really save a life.

首先，我担心的是结直肠癌，这也是我非常关注的问题。我认为，如今全国乃至全世界的每一位科学家都认为，为什么越来越多的年轻人患上结直肠癌，是我们这个时代最重要的科学问题之一。

So the things that I worry about first for colorectal cancer and something that I'm worried about a lot, I think every scientist in the country right now and in the world thinks is a is one of the most important scientific problems of our day is why are more and more younger people getting colorectal cancer?

因此，他们进行了一项研究，调查了早发性结直肠癌（即50岁之前发病）最常见的四种症状。

And so they did a study where they looked at what are the four most common symptoms of early onset, meaning before the age of 50, colorectal cancer.

但这些症状也适用于任何年龄段的结直肠癌。

But these also apply to colorectal cancer at any age.

明白。

Okay.

这四种症状分别是：第一，腹痛；第二，直肠出血；第三，缺铁性贫血。

And so these four symptoms are, one, abdominal pain, two, rectal bleeding, Three, iron deficiency anemia.

这是一种血液检查，能告诉我们你的红细胞变小了，这是由于铁流失造成的。

This is a blood test that tells us that your red blood cells have become smaller, and that's due to iron loss.

这对女性尤其重要，因为女性出现缺铁性贫血时，可能会感到疲劳，觉得没力气，这时候去做个血检就非常关键。

This is really important in women because when women have iron deficiency anemia and it can feel like fatigue, you're tired, You get the blood test.

人们常常会说，这一定是月经引起的，因为我们流失了很多铁。

Oftentimes, people will say this has to be due to your period because we lose a lot of iron.

我们在月经期间会失血。

We lose blood with our periods.

如果你有其他症状，或者你心想：等等，我的月经量其实很少。

If you have these other symptoms or you're like, wait a minute, but my periods are kinda light.

我真的很希望你能停下来，不要忽视这个问题。

I really want you to pause and not brush this aside.

第四个症状最重要，但也最模糊。

And then the fourth symptom is the most important and also the most vague.

真正让情况变得复杂的是，你的排便习惯发生了任何变化。

So it it's what makes it really complicated is any change in your bowel habits.

也就是说，出现了新的腹泻、新的便秘，或者排便模式发生了改变。

Meaning, new diarrhea, new constipation, some change to the pattern.

也许你的大便突然从很粗变得很细。

Maybe suddenly your bowel your poop went from being really thick to really, really thin.

任何对你来说是新的、并且持续存在的症状，都值得关注。

Anything that's new for you that seems to stick around, get attention.

因为这项研究发现，拥有我刚刚提到的四种症状中三种或四种的人，患结直肠癌的可能性是症状较少人群的六倍。

Because this study found that people who have three or four of the four symptoms I just mentioned, they had a six fold higher likelihood of having colorectal cancer than people who had fewer.

六倍？

Six fold?

六倍。

Six fold.

所以你有胃痉挛吗？

So you've got stomach cramps?

腹部疼痛。

Stomach abdominal pain.

腹痛。

Abdominal pain.

你有肛门出血的情况。

You have bleeding from your rear end.

是的。

Yep.

你有缺铁。

You have iron deficiency.

是的。

Yep.

而且你的排便习惯发生了变化。

And you have a change in kind of what is kinda historically your rhythm.

这种变化会持续多久？

And how long would you see that change stick around?

比如一周？

Like a week?

对。

Yeah.

如果这些症状持续了一两周，我就会去寻求帮助。

I I would go get help for any of these symptoms no more than one or two weeks if it's persisted.

而且确实有一些非常知名的名人表示，他们唯一的症状就是第四种——生活习惯模式发生了变化，起初他们以为是咖啡或其他原因，但后来换了咖啡，症状也没消失。

And and there have been some really high profile cases of celebrities who have said, the only sign I had was that fourth one, just that something changed in the pattern, and I thought it was, like, my coffee or something else, but it then I changed the coffee, and it didn't go away.

如果你感到担心，觉得有什么不对劲，别拖延。

If you're worried, if something's off, don't wait.

别把它当成正常现象而忽视。

Don't brush it aside as normal.

别为此感到尴尬。

Do not be embarrassed by it.

直接去问问你的医生。

Just run it by your doctor.

医生。

Doctor.

帕什里卡，你认为为什么有这么多年轻人不仅患上结肠癌，甚至因此丧命，这种令人担忧的趋势背后原因是什么？

Pasricha, why do you think there is this very troubling trend of so many young people not only getting but dying of colon cancer?

是的。

Yeah.

这是一个重要的问题。

It's it's a important question.

这是一个重大问题。

It's a big question.

我们过去通常认为癌症总体上是遗传和吸烟的结果。

We used to think about cancer in general as being a function of our genetics and smoking.

对吧？

Right?

但作为社会，我们已经大大减少了吸烟。

But we've stopped smoking so much as a society.

而且，显然我们的基因并没有改变。

And, obviously, our genetics aren't changing.

但随着世代更替，可能发生改变的是所谓的表观遗传学，即在基因本身之上发生的基因变化，这些变化可能由环境因素引起。

But what can change with generations is something called epigenetics or changes to our genes that occur on top of the actual gene itself that can be due to influences from our environment.

因此，随着这些病例的增加，我们越来越倾向于得出结论：我们的环境中一定有什么在发生变化。

So as these cases have been rising, we're arriving more and more at the conclusion that there has to be something in our environment that is changing.

而这种环境可能是我们呼吸的空气。

And that environment could be the air we're breathing.

也可能是我们接触到的化学物质。

It could be chemicals we're introduced to.

也可能是我们吃的食物。

It could also be the foods we're eating.

是的。

Yeah.

你不觉得是超加工食品以及包装食品中那些化学物质和垃圾成分吗？尤其是在美国，情况尤其如此。

Don't you think it's ultra processed foods and all the chemicals, the crap that's in food that's packaged and the people are especially here in The United States.

我确实这么认为。

I really do.

已经有一些重要的研究将结直肠癌在年轻人中的发病率与超加工食品的摄入联系起来。

And there have been some major studies that have linked colorectal cancer specifically at a younger age to ultra processed food consumption.

年轻患者中结肠癌的上升，在美国这样的国家是否更高？那里对超加工食品的监管非常糟糕。

Is the rise in colon cancer in younger patients, is that higher in a country like The United States where you have, like, horrible regulations when it comes to ultra processed foods?

这是一个全球趋势，这才是真正令人担忧的。

It's a global trend, and that's what's really worrisome.

好的。

Okay.

当然，超加工食品的增加并不仅仅局限于美国。

And, of course, the rise of ultra processed foods has not just been isolated to The United States.

它在世界各地都在发生。

It's been happening all over.

我们还发现，哈佛大学在护士健康研究中进行了一些大规模研究。

What we've also found and they've done some really big studies here at Harvard in the Nurses' Health Study.

他们发现，儿童和青少年时期饮用含糖饮料越多的人，成年后越容易患上早发性结直肠癌。

They found that people who drink more, for example, sugar sweetened beverages as children, as teenagers, they're more likely to develop early onset colorectal cancer once they become younger adults.

作为社会，我们饮用这些含糖饮料的量越来越多。

And we've been drinking more and more of these sugar sweetened beverages as a society.

我们看到这一趋势自1927年以来一直在持续，与超加工食品的增加同步发生。

We've seen that trend happen over time since the '27 to '27 is alongside with ultra processed foods.

所以这可能是许多不同因素的综合作用。

And so it's probably a combination of a lot of different things.

我也告诉我的所有患者，尤其是当我做出这个诊断时，首先，癌症不是你的错。

I I also, you know, I tell all of my patients, especially when I'm making this diagnosis that, first of all, cancer is not your fault.

也从来不是别人的错。

It is never someone else's fault.

癌症是由太多因素造成的，其中一些我们能控制或部分控制，但很多是我们无法控制的。

Cancer is the result of so many things, some of which we have control over or some control over, many of which we do not.

对吧？

Right?

有时候你会对自己说，不可能是超加工食品造成的。

And sometimes you say to yourself, it can't be ultra processed food.

我经常听到这种说法。

I hear this a lot.

不可能是酒精造成的。

It can't be alcohol.

不可能是超加工食品，因为

It can't be ultra processed food because

说实话，我怎么能不这么想呢？

How can I not, honestly?

人们会说，我阿姨每天喝七杯酒之类的，但她活到了90岁。

Like People will say, well, my aunt, you know, drank, you know, seven drinks, you know, like a day or whatever, and and she lived to be the age of 90.

我试图向人们解释的是，把癌症想象成用积木搭一座塔。

And what I try to explain to people is that think about cancer as building a tower of building blocks.

我是这样向他们解释的。

This is how I explain it.

有些人一生下来就已经有五块积木压在他们身上，只要再加十块就会得癌症。

Some people start out life with five blocks stacked against them, and it only takes 10 to get cancer.

你的阿姨可能一生下来只有的一两块积木。

You, your aunt, may have started out with just one or two blocks.

假设你每天吃很多加工肉类。

And then suppose you eat a lot of processed meats every day.