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a few years ago, i always had this thing happening to me, especially at family gatherings like teas with aunts and unclesor something like this. when people come up to you, and they ask you,"so, what are you doing?" and i would havethis 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 lastsfor 30 seconds with me, because that's then the timewhen 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 downin all honesty and just say, "ok, so i'm fascinated with the colon.
it all started with the anus, and now it's basicallythe whole intestinal tract." (laughter) and this would be the momentwhen 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 believeour bowels are quite charming. and while we're in a timewhere many people are thinking about what new superfood smoothie to make
or if gluten is maybe bad for them, actually, hardly anyone seems to careabout the organ where this happens, the concrete anatomyand the mechanisms behind it. and sometimes it seems to me like we're all tryingto 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 sciencedisliked the gut for a long time; i have to say this. 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 cellsthat are being trained there. we have 100 trillion bacteriadoing all sorts of things -- producing little molecules.
then there's about 20 different hormones, so we are on a very different levelthan our genitals, for example. and the nervous systemof our gut is so complex that when we cut out a piece, it's independent enoughthat when we poke it, it mumbles back at us, friendly. but at least those reasons are alsothe reasons why it's so fascinating and important. it took me three steps to love the gut.
so today, i invite you to follow meon those three steps. the very first was just looking at it and asking questionslike, "how does it work?" and "why does it have to lookso weird for that sometimes?" and it actually wasn't me askingthe 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?"
and i did study medicinebut i had no idea, so i had to go up to my roomand look it up in different books. and i found something interesting,i thought, at that time. so it turns out, we don't only havethis 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 deliveredto the inner one first. this inner one will open in a reflex and let through a little bit for testing. so, there are sensory cells that will analyze what has been delivered:is it gaseous or is it solid? and they will then sendthis information up to our brain, and this is the momentwhen our brain knows, "oh, i have to go to the toilet."
the brain will then dowhat 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 -- " (applause) gaseous? maybe, if you're sitting on the sides,
and you know you can pull it off silently. but solid -- maybe later. since our outer sphincter and the brainis connected with nervous cells, they coordinate, cooperate, and they put it back in a waiting line -- for other times, like, for example, when we're at homesitting on the couch, we have nothing better to do,
we are free to go. us humans are actually oneof 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 aboutthe outer world or the time -- just caring about me for once. i thought that was nice.
and i used to not be a great fanof public restrooms, but now i can go anywhere, because i consider it more when that inner muscle puts a suggestionon my daily agenda. and also i learnedsomething else, which was: looking closely at somethingi 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 rumblingnoises 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 intestineis actually a huge neat freak, and it takes the time in between digestionto clean everything up,
resulting in those eight metersof gut -- really, seven of them -- being very cleanand hardly smelling like anything. it will, to achieve this,create a strong muscular wave that moves everything forwardthat's been leftover after digestion. this can sometimes create a sound, but doesn't necessarily have to always. so what we're embarrassed ofis really a sign of something keepingour insides fine and tidy. or this weird, crooked shapeof our stomach --
a bit quasimodo-ish. this actually makes us be ableto put pressure on our belly without vomiting, like when we're laughing and when we're doing sports, because the pressure will go upand not so much sideways. this also creates this air bubble that's usually always very visiblein x-rays, for example, and can sometimes, with some people,
when it gets too big, create discomfortor even some sensations of pain. but for most of the people,is just results that it's far easier to burpwhen you're laying on your left side instead of your right. and soon i moved a bit further and started to look at the whole pictureof our body and health. this was actually after i had heard that someone i knew a little bithad killed himself.
it happened that i had been sittingnext to that person the day before, and i smelled that he had very bad breath. and when i learnedof the suicide the next day, i thought: could the gut havesomething to do with it? and i frantically started searchingif there were scientific papers on the connection of gut and brain. and to my surprise, i found many. it turns out it's maybe not as simpleas we sometimes think. we tend to think our brainmakes these commands
and then sends them downto the other organs, and they all have to listen. but really, it's more that 10 percentof the nerves that connect brain and gut deliver informationfrom the brain to the gut. we know this, for example,in stressful situations, when there are transmitters from the brainthat are being sensed by our gut, so the gut will try to lower all the work, and not be workingand taking away blood and energy to save energy for problem-solving.
this can go as far as nervous vomitingor nervous diarrhea to get rid of food that it thendoesn't want to digest. maybe more interestingly, 90 percent of the nervous fibersthat connect gut and brain deliver informationfrom 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 skullsurrounded by a thick skin, and it needs informationto put together a feeling
of "how am i, as a whole body, doing?" and the gut, actually, is possiblythe most important advisor for the brain because it's our largest sensory organ, collecting information not onlyon the quality of our nutrients, but really also on how are so manyof our immune cells doing, or things like the hormonesin our blood that it can sense. and it can package this information,and send it up to the brain. it can, there, not reach areaslike visual cortex or word formations -- otherwise, when we digest,
we would see funny colorsor we would make funny noises -- no. but it can reach areasfor things like morality, fear or emotional processing or areas for self-awareness. so it does make sense that when our body and our brainare putting together this feeling of, "how am i, as a whole body, doing?" that the gut has somethingto contribute to this process. and it also makes sense
that people who have conditionslike irritable bowel syndrome or inflammatory bowel disease have a higher risk of havinganxiety or depression. i think this is good information to share, because many people will think, "i have this gut thing, and maybei also have this mental health thing." and maybe -- because science is notclear on that right now -- it's really just that the brainis feeling sympathy with their gut. this has yet to grow in evidenceuntil it can come to practice.
but just knowing aboutthese kinds of research that's out there at the moment helps me in my daily life. and it makes me thinkdifferently of my moods and not externalize so much all the time. i feel oftentimes during the daywe are a brain and a screen, and we will tend to lookfor answers right there and maybe the work is stupidor our neighbor -- but really, moods can alsocome from within.
and just knowing this helped me, for example, when i sometimeswake up too early, and i start to worry and wanderaround 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 upand make myself a tea, something light to digest. and as simple as that sounds,
i think it's beensurprisingly good for me. step three took me furtheraway from our body, and to really understandingbacteria differently. the research we have todayis 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 havetoo little microbes in your environment because you clean all the time,
that's not really a good thing, because people get more allergiesor 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. it turns out, real cleanliness is not aboutkilling off bacteria right away. real cleanliness is a bit different.
when we look at the facts, 95 percent of all bacteria on this planetdon'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 momentare looking into things like: do some bacteria help us clean the gut? do they help us digest? do they make us put on weightor have a lean figure although we're eating lots?
are others making us feel more courageousor even more resilient to stress? so you see, there are more questionswhen 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 iswhen 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. so i started having this differentperspective 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 realizedin that moment, i was like, "ah! i madea 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 manygood 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 perspectiveon cleanliness further." and it's my theory at the momentthat maybe we all do.
take it a bit further than justcleaning our living room, where maybe we make itto sort like a life hygiene. knowing that this is aboutfostering the good just as much as trying to shelteryourself from the bad had a very calming effect on me. so in that sense, i hope today i told youmostly good and helpful things, and thank you for your time, for listening to me.