MANOUSH ZOMORODI, HOST:
It's the TED Radio Hour from NPR. I'm Manoush Zomorodi. Today on the show, how we learn about our bodies and tell fact from fiction.
JEN GUNTER: Well, I think the issue is the medical internet is both amazing and is awful. And it shouldn't be that kind of crapshoot.
ZOMORODI: This is Dr. Jen Gunter.
GUNTER: I am an OB-GYN and a pain medicine physician and an author and podcaster.
ZOMORODI: Jen is also internet famous for calling out celebrities who share misinformation about health and wellness.
GUNTER: I would say that my mission is to give people factual, accessible information about their health because I want people to be empowered about your health. But you can only be empowered with accurate information.
ZOMORODI: And for her, part of empowering people is to write guides to traditionally taboo women's health topics, including one called "The Vagina Bible" and her latest, "The Menopause Manifesto." She also recently started a podcast called "Body Stuff."
(SOUNDBITE OF PODCAST, "BODY STUFF")
GUNTER: I'm Dr. Jen Gunter. I love science. And I hate [expletive].
ZOMORODI: In 2019, Jen gave a TED Talk called "Why Can't We Talk About Periods?" And today she's brought us a selection of TED Talks, ones that have influenced her as she's become an outspoken critic on how society uses language and psychological tactics to shame and trick people about their basic bodily functions. Her story goes back 17 years ago when Jen herself was having a health crisis.
GUNTER: I initially got interested in how people access information online because I was in that position. And so that really started it, when I had my pregnancy. And I had a triplet pregnancy, but it was incredibly complicated. And one of my sons died at birth, and my other two boys were in the intensive care unit for a long time.
ZOMORODI: I'm so sorry.
GUNTER: And so - and they had all these other medical problems as well as prematurity. And when I didn't get answers from my own doctors, I went online. And I was horrified. This was sort of the earlier stages of the medical internet, if you will. And I just thought, wow. If it's so hard for me to get practical information, like, useful information that can help me today...
ZOMORODI: As a physician.
GUNTER: Right. As a physician caring for my babies, right? Like, I wanted help. I wanted - there's gaps in medicine. You know, your doctors can tell you stuff. But they can't tell you, like, what are the tips and tricks for taking your babies out in a stroller when you have two children on oxygen, right?
ZOMORODI: Oh, my gosh.
GUNTER: Like, those are things that other experienced parents can tell you. But then, how do you know you're getting that right information? So I realized there were so many gaps that were important but not covered by medicine and how easy it was to fall down snake oil-filled rabbit holes, for lack of a better word. And I just thought if I was struggling like this - me, this person who's always been obsessed with evidence-based medicine - how was everyone else managing? And so I decided that I was going to fix the medical internet.
ZOMORODI: (Laughter) Just a small goal, really, Jen?
GUNTER: Right. That's - I was very naive about it.
ZOMORODI: OK. So naive, but absolutely driven. And you're still doing that. And we're going to talk about some of the talks that have sort of propelled you as you try to fix the medical internet. But first, let's talk about your own talk. It's called "Why Can't We Talk About Periods?" And, Jen, from what I understand, you had absolutely terrible periods as a teenager. But you felt like you didn't have anyone to really talk to about your symptoms.
GUNTER: Right. I mean, as far as my mother was concerned, you didn't talk about anything from down there. And she suffered with periods. So suck it up, sister.
GUNTER: And, yeah, so there was just - there's no information. And so I spent two days each month curled up with a heating pad. I couldn't go to school. And, you know, why was this happening? Why was I suffering so much? And it just felt to me like this big biological flaw.
ZOMORODI: And did you ask your doctor, like, what is going on?
GUNTER: I think I didn't actually get taken to one until maybe I was like 16. So I'd been suffering for, you know, several years. And my mother took me to her doctor, who basically said, yeah, period. Yeah. That's it. So basically, you know, it was just no practical information. And it's sad to me that, you know, that happened in the, I guess, early 1980s and that I still hear that same story from young women today.
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ZOMORODI: And in your talk, you go back to kind of the historical roots of why you didn't have any access to information and you felt ashamed of this bodily function.
(SOUNDBITE OF TED TALK)
GUNTER: Why can't we talk about periods? And it's not about the blood, as Freud would have you say, because if it were, there'd be an ear, nose and throat surgeon up here right now talking about the taboos of nosebleeds, right? And it's not even about periods because otherwise, when we got rid of our toxic, shameful periods when we became menopausal, we'd be elevated to a higher social status.
GUNTER: It's just a patriarchal society is invested in oppressing women. And at different points in our lives, different things are used. And menstruation is used during what we in medicine call the reproductive years. It's been around since pretty much the beginning of time. Many cultures thought that women could spoil crops or milk or wilt flowers. And then when religion came along, purity myths only made that worse. And medicine wasn't any help. In the 1920s and '30s, there was the idea that women elaborated something called a menotoxin (ph). We could wilt flowers just by walking by.
ZOMORODI: OK, so how have things changed? Let's fast-forward to when you were becoming a gynecologist. Are doctors taught - well, I guess there's two things. Were they taught, when you were in medical school, to speak more frankly about this stuff? And what about today when you talk to medical students? You know, what's the status quo now?
GUNTER: Well, certainly, in the realm of gynecology, these words have always been used. But the publicability, this ability to talk outside of an office, is, I think, relatively new, right?
ZOMORODI: Yeah, yeah.
GUNTER: You know, '50s, '60s, '70s, '80s, your uterus is trouble; we don't hear about it. You know, really, I think it's sort of taken social media and being online to sort of raise the noise level enough that the conversation is catching.
ZOMORODI: That's exactly what you do in your talk. You tell the audience what you tell your patients about how their periods work.
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GUNTER: Well, what if everybody knew about periods like a gynecologist? Wouldn't that be great? Then you would all know what I know. You'd know that menstruation is a pretty unique phenomenon among mammals. Most mammals have estrous. Humans, some primates, some bats, the elephant shrew and the spiny mouse menstruate. And with menstruation, what happens is the brain triggers the ovary to start producing an egg. Estrogen is released, and it starts to build up the lining of the uterus, cell upon cell, like bricks. And what happens if you build a brick wall too high without mortar? Well, it's unstable.
So what happens when you ovulate? You release a hormone called progesterone, which is progestational. It gets the uterus ready. It acts like a mortar, and it holds those bricks together. It also causes some changes to make the lining more hospitable for implantation. If there's no pregnancy, lining comes out. There's bleeding from the blood vessels, and that's the period. And I always find this point really interesting because with estrous, the final signaling to get the lining of the uterus ready actually comes from the embryo. But with menstruation, that choice comes from the ovary. It's as if choice is coded in to our reproductive tract.
ZOMORODI: You got big cheers there. You get a little political there at the end, Jen. Do you think politics and medicine - I mean, clearly they've always been intertwined when it comes to women and reproduction. Have they always been intertwined for you?
GUNTER: I think so. You know, when I started in medical school, to get an abortion in Manitoba required approval of a three-person panel, and you didn't even get the privilege of pleading your own case in person. You told your family doctor, who then submitted a letter on your behalf.
GUNTER: How wrong is that? And throughout the history of humanity, how medicine has been accessed for women is different than how it has been accessed by the people in power, men. And so, yeah, I think if you want to care for people and you want to help them medically, politics is simply part of it.
ZOMORODI: There are a lot of folks, of course, who either because they can't or they won't go see a doctor, they look for information online now. You know, you go - back in the day, you'd go to the library. Nobody's there trying to sell you products at the same time - right? - whether that's to promote cleanliness or vagina health or, like - I actually was at the doctor's office today, and they were touting a three-pack. After you give birth, you know, come back. We'll slim down your tummy and tighten up your pores and, like, three procedures, plastic surgery procedures, for the low, low price of like - I think it was $7,500. I was like, what? That - huh? There's this overlap between medicine and the commoditization of what women need to do to be healthy/well/look good.
GUNTER: Yeah. Every now and then, I get messages from people who've been at the gynecologist. And while they're sitting there waiting, wearing a robe, naked in the office, they look on the wall, and there's an advertisement for some kind of vaginal enhancement procedure. And...
ZOMORODI: I saw that.
GUNTER: Yeah. And how at your most vulnerable - you're naked in a doctor's office and you see that. And you're supposed to be there to get factual, accurate information about your vagina, your vulva, your body. And to have this implication on the wall that there's something troublesome with your body, I have a problem with that. I think that cosmetic procedures need to not be folded in with annual exams and seeking care for medical problems.
ZOMORODI: So let's go back to your talk. Part of being able to look away from a lot of these advertisements or be like, that's ridiculous, is knowing how your body works, right?
GUNTER: Exactly. Information is power. Knowledge is power.
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GUNTER: It shouldn't be an act of feminism to know how your body works. It shouldn't...
GUNTER: It shouldn't be an act of feminism to ask for help when you're suffering. The only curse here is the ability to convince half the population that the very biological machinery that perpetuates the species, that gives everything that we have is somehow dirty or toxic. And I'm not going to stand for it.
GUNTER: And the way we break that curse - it's knowledge.
ZOMORODI: In a minute, we'll be back with physician and author Jen Gunter and more facts about how our bodies work. I'm Manoush Zomorodi, and you're listening to the TED Radio Hour from NPR. Stay with us.
It's the TED Radio Hour from NPR. I'm Manoush Zomorodi. And today, our guest is Dr. Jen Gunter. She's a practicing OB-GYN and physician but has also made a name for herself debunking celebrity wellness trends and helping us make informed decisions about our health.
GUNTER: Yeah. I mean, I think debunking is an extension of my quest to know. All sort of misinformation, you know, has this root in not being informed. And I just think that so much of medicine is not that difficult. It might be complex. And obviously you don't need to know all of the nuances of everything to have a good working knowledge. But the good working knowledge - a lot of it's not really that hard. It's just our ivory tower makes it seem like it is. And so I want that to be as accessible to everyone as it is to me.
ZOMORODI: That, I think, is the common theme of all the talks that you have chosen for us this hour. And so that brings me to the first talk that you've chosen, which is from Lera Boroditsky. Lera is a cognitive scientist, and she gave her talk in 2017. It's called "How Language Changes The Way We Think" (ph). OK, why was this - you were like, yes, I will pick talks for you, and we got to start with this one. Why?
GUNTER: Because this changed a lot of things for me. I remember reading about this talk, like, when it came out, and I remember seeking it out and listening to it and then being like, whoa. Whoa. The idea that the words we use can shape our thoughts, I mean, it makes so much sense when you hear someone say it. But until someone actually studies it, how do you know? And then when you hear, like, wow, whether I think something is weak or strong could be affected by the words I choose for that, it's pretty powerful.
(SOUNDBITE OF TED TALK)
LERA BORODITSKY: There are about 7,000 languages spoken around the world, and all the languages differ from one another in all kinds of ways. Some languages have different sounds. They have different vocabularies. And they also have different structures. That begs the question, does the language we speak shape the way we think?
Now, this is an ancient question. People have been speculating about this question for forever. Charlemagne, Holy Roman emperor, said, to have a second language is to have a second soul. Strong statement that language crafts reality. But on the other hand, Shakespeare has Juliet say, what's in a name? A rose by any other name would smell as sweet. Well, that suggests that maybe language doesn't craft reality. These arguments have gone back-and-forth for thousands of years. But until recently, there hasn't been any data to help us decide either way.
ZOMORODI: OK, so we should say Lera was one of the first linguists to question what most experts in the field believed to be true, that all languages have a common underlying structure. So, you know, even though we make different sounds with our mouths or use different words, when we speak different languages, we're all pretty much thinking the same. But she says that over the past 20 years, that has been debunked. And, Jen, you told me that Lera had a big influence on you and how you think about things medically. Can you tell me why?
GUNTER: Yeah. So I started thinking about, wow, if words affect, like, how we might think about things, if they can reversely craft our thoughts, if you will, I started to think about medical terms. Until relatively recently, you know, doctors learned Latin and Greek, and they learned all what all the roots meant. And I think some of that's been forgotten now, and I guess that's good. But the word pudendum, which is used to describe the sort of external genitalia, mostly for women, so the vulva and around the anal area - well, the Latin root for that, pudere, is to shame. And the clitoris - the root for that is to hide. And the hymen is named after the Greek god of marriage.
GUNTER: Right? So we're actually - when we're seeing those words, we're imbuing those body parts with false information.
ZOMORODI: It's such an interesting way to think about it. So I grew up speaking German to my mother. And German has gendered articles. And in Lera's talk, her section about how gendered language can affect how we view things, like literal things, was something I'd wondered about, like, for years. But she put a finer point on it.
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BORODITSKY: Lots of languages have grammatical gender. So every noun gets assigned a gender, often masculine or feminine, and these genders differ across languages. So, for example, the sun is feminine in German but masculine in Spanish, and the moon the reverse. Could this actually have any consequence for how people think? Do German speakers think of the sun as somehow more female-like, the moon somehow more male-like? Actually, it turns out that's the case. So if you ask German and Spanish speakers to, say, describe a bridge, like the one here - bridge happens to be grammatically feminine in German, grammatically masculine in Spanish - German speakers are more likely to say bridges are beautiful, elegant, stereotypically feminine words, whereas Spanish speakers will be more likely to say they're strong or long, masculine words.
ZOMORODI: That's fascinating. So as someone who talks a lot about gender, how does what Lera says about gendered language strike you, Jen?
GUNTER: Well, first of all, I have to point out that I'm fascinated that long is a masculine word.
GUNTER: I think - and we all know why.
ZOMORODI: Little too on the nose, right?
GUNTER: Yeah. Exactly. I think it's fascinating because we assign physical qualities to gender. And we judge people by these physical qualities. And I don't think that's right. Any person can be beautiful. Any person can be strong. But these are sort of these - again, these stereotypical, patriarchal concepts that, you know, never really had any place in medicine or in language. But, you know, now that we know that gender is fluid and people shouldn't be judged by their gender, like, these are things that we should strive to move away from. These seem like a remnant of an older time that we should evolve from.
ZOMORODI: I can just imagine some people listening would think like, oh, come on. Like, so these gendered pronouns, these are languages that have evolved over centuries. What do you want us to do?
GUNTER: I guess what I would say is we evolve. And we change. And as we learn things, we take that in. And I think what we don't realize is so much of what we think is true or what we think is convention is actually something that's been forced upon us by those in power. And so why not evolve if it makes everything better for people? If we can change language to be more inclusive, to bring more people to the table, isn't that a good thing? I mean, I have a hard time finding downsides with that.
ZOMORODI: So how we are influenced to think certain things is also at the heart of the next talk that you chose to bring us. It's from a man named James Randi, whom I had not heard of, but who was a very famous illusionist-turned-professional-debunker. I read with fascination his obit in the Times because he just died last year at the age of 92. The talk he gave in 2007 is called "Homeopathy, Quackery And Fraud." And you - again, you were like, oh, we need to talk about this, about James Randi. What - have you always been a James Randi fan?
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GUNTER: No, relatively recently. So yeah, I love how James Randi calls himself a conjurer.
(SOUNDBITE OF TED TALK)
JAMES RANDI: I have a very peculiar background, attitude and approach to the real world because I am a conjurer. I prefer that term over magician because if I were a magician, that would mean that I use spells and incantations and weird gestures in order to accomplish real magic. No. I don't do that. I'm a conjurer, who is someone who pretends to be a real magician.
GUNTER: I didn't know, really, anything about the Amazing Randi or magic or anything until his organization asked me to speak a few years ago.
GUNTER: And I think it's fascinating because, you know, people who practice snake oil, people who push quackery are essentially lying about being a conjurer. And magicians - or conjurers are honest about it, right? They're honest about it. And fun fact, I'm - you know, I'm now partnered with the love of my life, who's actually a magician (laughter).
ZOMORODI: No. Come on.
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RANDI: Now, how do we go about that sort of thing? We depend on the fact that audiences, such as yourselves, will make assumptions. For example, when I walked up here and I took the microphone from the stand and switched it on, you assumed this was a microphone, which it is not.
RANDI: As a matter of fact, this is something that about half of you - more than half of you will not be familiar with it. It's a beard trimmer - you see? - and makes a very bad microphone. I've tried it many times.
ZOMORODI: (Laughter) OK. So James was holding a beard trimmer instead of a microphone. Jen, why do you think his talk has stuck with you?
GUNTER: Well, I think that's how a lot of misinformation spreads. It's based on assumptions. And if you look at the marketing for a lot of, you know, snake oil or medical misinformation, you know, they use a lot of terms and rhetoric, terms like God words, terms where we fill in the blank about what we assume to be true. So if I say something is natural or I say something is ancient, you automatically fill in the blank that that thing is probably a good thing for you, right?
GUNTER: So when those marketing terms are used, they're being used because they know you will make an assumption about it.
ZOMORODI: His life was very interesting in that he was a follow-up to a lot of Houdini's sort of, you know, getting out of boxes that were sunk in hundreds of feet of water, all kinds of things. But then sort of midway through his life, he stopped escaping and started, really, on this mission to try and help people who had sunk hundreds, thousands of dollars into things like seances, being contacted to the dead, homeopathic medicine. He had a big career switch. I guess you would say, though, that those two things are related in some ways.
GUNTER: Absolutely, because all of these sort of fake medical things are using tricks. And they're preying on people. I mean, there's some - I don't know if you remember back in - I think it might have been the '80s, when people were performing that so-called, like, bloodless surgery, you know? They went to these other countries. And there were these incredible videos where it looked like people were plunging their hands into abdomens and pulling out diseased body parts.
ZOMORODI: Oh, yes. Yes.
GUNTER: Right. I think that's kind of how Randi maybe got sort of involved with it. Or there was - there were these sort of televangelists, sort of preacher types who would have these auditoriums filled with people. And you'd get healed, you know? And they'd call out the person - is Mary Smith (ph) here? Is Mary Smith here? And, of course, Mary Smith would come up. And then they'd say, well, oh, Mary Smith, you live here, and you have this daughter here. And, you know, the person was being fed all this information in an earpiece. So - you know, people are spending money. And if they have cancer, they're getting harmed - or they have an illness - because they might not be getting the treatment they need.
ZOMORODI: Yeah. So homeopathic medicine, he definitely takes aim at that. And, Jen, what is your issue with homeopathic medicine?
GUNTER: So homeopathy means something that has been diluted to the point where there's essentially, like, one molecule in - you know, like, diluted to the point where the water has memory of the original substance. That's...
ZOMORODI: Oh, that's what it means?
GUNTER: That's what homeopathy is. Yeah. It's - so you take something that's like the original thing, like a syphilitic ulcer, and you put it in water to - or alcohol or whatever - to make a solution. And then you dilute it out and dilute it out and dilute it out and dilute it out, you know, maybe, you know, a hundred times or 60 times or 1,000 times or whatever the dilution is. And then that product that you end up with is the homeopathic product.
ZOMORODI: So that's different than a midwife saying, make sure you drink some of this herbal tea, which will stimulate your milk production...
ZOMORODI: ...Or Chinese medicine and herbs. That's not considered homeopathy?
GUNTER: No. Those are completely different things. And each one of those interventions deserves to be studied - right? - to see if they're effective or not, because you have to remember, if something is producing a biological effect, then there is something pharmaceutical about it, right? And so the assumption should not be that that is benign or safe, right?
So, I mean, a tragic example is, you know, a lot of old-time recipes for menstrual problems, which was often a euphemism for being pregnant, but not always, involved a substance called pennyroyal, which is horribly toxic to the body and often fatal when consumed. It certainly can induce uterine contractions. But, you know, death of the person taking it's kind of an undesired side effect. So - yeah, so can this herbal thing produce the effect? If it's producing an effect, you should be able to prove it.
ZOMORODI: You mentioned this very briefly at the beginning of our conversation, but you have a lot of empathy. You've written that you have a lot of empathy for people who do want to believe all kinds of things because of a personal tragedy that you had. Can you just elaborate a little bit more about what you think the mindset is?
GUNTER: Sure. I mean, you're desperate, you know? When my kids were in the intensive care unit and my son, you know, 1 pound, 11 ounces - and on top of that, he was diagnosed with an uncommon heart defect, nothing to do with being premature - right? - so just one bad thing on top of another. And he needed to have surgery to fix this complex heart defect, but he was too small for the equipment, you know?
And I had another son who vomited after every single feed because his - just his - you know, his whole system wasn't developed yet. And so the first two years of his life, everything was a vomit, you know? I smelt - the back of my hair smelt like vomit - I'm not kidding - for two years. And, you know, he developed all kinds of - he couldn't eat solid food because of that because it's worse to vomit up solids than it is to vomit up liquids.
GUNTER: He didn't have his first solid food until he was 3 1/2.
GUNTER: So I got lost in all these food blogs and food allergy things and - because you're desperate. I mean, here I've got this - you know, my son is 3. He hasn't eaten a bite of solid food. You can't even put it on his lip - and he freaks out. And you've done everything medicine has given you. You've done everything. You've gone to three different occupational therapists. You've tried this. You've tried that. You've had these interventions. And you're in this space where there is nothing to do but to wait. And it's a very vulnerable place to be. So I get it.
ZOMORODI: I mean, it goes back to what you said before about knowledge and accurate information being crucial. And, I mean, I guess it's - feels or seems strange to lump homeopathic medicine and belief in the supernatural with misinformation in general. But I think what I'm hearing you say is that, especially for people who are in that vulnerable space, they can be gateways in some way.
GUNTER: Yeah. I think that social media and the way we consume news in this 24/7 news cycle is this toxic combination that lets misinformation just metastasize, because there's this concept called the illusory truth effect. We all mistake repetition for accuracy. And so if you see the same story on your Instagram feed - and maybe you see it two or three times because maybe several influencers that you follow post it. And then you see it on your Facebook feed because what chases you on Facebook - what you saw on Instagram, right?
GUNTER: And then you see some people. And then maybe you decide, oh, look; there's this Facebook community that was recommended for me. And all these people seem nice. And then you get in there. And then all of a sudden, they're talking about conspiracy theories. And maybe you heard about that somewhere, but you don't quite remember where. It's really - we've created this echo chamber where the misinformation reverberates. And you know what? The misinformation is often fantastical and a bit like, whoa. And the truth is so stodgy and boring sometimes. And so how do you have - how does the stodgy truth about - you know, about the immune system, you know, how does that compete with it, you know? - like, wah-wah, wah-wah, wah-wah, and, you know, like in the "Peanuts" comic. And we have to learn to communicate in ways that people can hear.
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ZOMORODI: In a minute, more from Dr. Jen Gunter and her mission to talk openly about basic bodily functions, like defecating. Today on the show, The Truth About Our Bodies. I'm Manoush Zomorodi, and you're listening to the TED Radio Hour from NPR. Stay with us.
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ZOMORODI: It's the TED Radio Hour from NPR. I'm Manoush Zomorodi. Today on the show, debunking misinformation, stigma and shame about our bodies. Our guide through a selection of TED Talks is physician, author and podcaster Jen Gunter. And one topic in particular that Jen wants to demystify for us is poop.
GUNTER: Everybody poops. This is one of those things people never talk about, but...
ZOMORODI: So true.
GUNTER: Like, why is your poop any more shameful than your runny nose? That's what I want to know.
ZOMORODI: It doesn't smell the same, does it? OK, wait. We're going to get to that.
ZOMORODI: But let's start with the talk that you have brought us, which is by Dr. Giulia Enders, called "The Surprisingly Charming Science Of Your Gut."
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GIULIA ENDERS: It took me three steps to love the gut. And the very first was just looking at it and asking questions like, how does it work and why, maybe, 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. So after one heavy night of partying, he came into our shared-room kitchen, and he said, Giulia, you study medicine. How does pooping work?
ENDERS: 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. So 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 send this information up to our brain. And this is the moment when our brain knows, oh, I have to go to the toilet.
ZOMORODI: I mean, is she - she's the most charming doctor. She's just the best. And it really - it reminds me of a friend of mine who I used to go on a lot of work trips with, and he used to go, (imitating trumpet). And that was - the trumpet noise was when he had to excuse himself. But most people are not that comfortable - well, other than little kids - are not that comfortable about talking openly about the need to go or pooping, right?
GUNTER: Right. But they want to be (laughter).
ZOMORODI: That is true. Tell me more about that.
GUNTER: You know, I talk a lot about poop in the office, how to have bowel movement. I take care of a lot of people who have pelvic pain. And a lot of times, that's related to the same muscles that you use for defecation, to have a bowel movement. So there's a lot of crossover. And so chronic constipation can actually lead to pelvic pain and vice versa. So I'm always talking to people like, do you mechanically know how to have a bowel movement? And people are like, there's a way? I'm like, there is. We talk about, you know, that - why you really need to have fiber, why you really need to have these things. You know, people - we say, oh, you must have fiber; you must have fiber. But people want to know the why. They want to know the why.
(SOUNDBITE OF TED TALK)
ENDERS: Like, those funny rumbling noises that happen when you're in a group of friends or at the office conference table going like, (imitating stomach rumbling). This is not because we're hungry. This is because our small intestine's 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 smell like anything. It will, to achieve this, create a strong muscular wave that moves everything forward that's been left over 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.
ZOMORODI: Can we just clarify one thing? First of all, I need to know about the right way to poop. And second of all, poop is basically just waste, right?
GUNTER: Right, absolutely. It's all the leftovers that you don't need, plus cells from the lining of your colon and bacteria and indigestible fiber, the - you know, sort of the nonsoluble fiber. So, yeah, so the leftovers, if you will, and some other stuff along for the ride. You know, there might be a little bit of gas that a lot of us might think smells a bit like sulfur, and it's because of the bacteria, right? So we depend on bacteria inside our bodies to help with digestion, to help with so many things. I mean, we have this important microbiome. And I think also, too, you know, a lot of our misconceptions about the colon come from before we knew about the microbiome, actually, right?
ZOMORODI: Oh, yeah.
GUNTER: So it's sort of a different story to say, well, you have gas because you normally have this bacteria that's helping you break down food and produce vitamins, and it's really important part of your health, and so you should be proud of your sulfur...
GUNTER: ...Because that means you've got a healthy microbiome - right? - as opposed to, you should be ashamed of it.
ZOMORODI: OK, I'm going to try. But I should say, you know, earlier we mentioned that you are now doing a podcast. It's called "Body Stuff." And this talk, the one that we've been discussing, is - it particularly speaks to you because you have an entire episode dedicated to poop. And you talk to a rather unusual expert who says we were not always so embarrassed to talk about it.
GUNTER: So we talked to Dr. Barbara Penner, who's an architectural historian. And, you know, she wrote a book called "Bathroom" about how toilet design and ideas about poop have, I guess, shaped each other. And that's one of the great things about expanding your search for knowledge beyond, like, just medicine. Like, medicine's part of society. Like, you have to look at all of society to understand where we are.
ZOMORODI: Right, which is exactly what you and Dr. Barbara Penner explain in your podcast.
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BARBARA PENNER: If we look at pre-modern times, let's say pre-18th century, there are loads of examples of two- and three-seater outhouses.
GUNTER: Seats for people to poop side by side.
PENNER: And these really remind us that there just was not the same sense of shame around bodily functions. And we know that for many people, going to the toilet could even be a time for socializing.
GUNTER: And that was totally normal until the 19th century, the Victorian era in England. That's when indoor plumbing became much more available in England and the U.S., and it's when we learned more about how disease is spread.
ZOMORODI: OK, so let's time travel back to today. And the goal with pooping, I mean, I think it's pretty fair to say, is that everyone just wants their - sorry, listeners, to speak for you, but everyone (laughter) wants their poop to be regular and normal, like once a day, fully formed. Is that the right goal?
GUNTER: Well, yes and no. Their poop should be regular for them. So what's regular and normal for me might not be regular and normal for you. You want the system to be working fine. So if once a day is what happens for you, that's great. If it's twice a day, that's fine. If it's every other day, that's OK. You know, so instead of thinking about, like, how often, you should think about more, like, is there any discomfort? Am I feeling unwell otherwise? Is there blood in my stool, which is certainly a very concerning sign and should always be reported to your doctor? You should just think about it in terms of health. I always think your body's kind of working the best when you're not really thinking about it.
GUNTER: And also a change - people should be aware of changes. So if everything was going right, and then all of a sudden there's a change for you, then that's something to think about.
ZOMORODI: What I like about you, Jen, though, is that you don't just talk about the negative stuff. You also talk about the positive stuff. And in this episode about poop, you have an expert with you, and you introduce some terminology that I had never heard called poo-phoria, which is the lovely side of pooping.
GUNTER: Yes. Our doctor of poo-ology (laughter), our gastroenterologist is Dr. Anish Sheth. And he wrote the book "What Your Poo Is Telling You" (ph).
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GUNTER: So what's a monster poo?
ANISH SHETH: Monster poo just means you're just having a large, huge bowel movement. When you have a monster poo, you can experience this sort of sense of joy and elation that we call poo-phoria, right? It comes from sort of distending the rectum, which we talked about as being a very sensitive area, and then having it decompress sort of in a single bolus of stool as it comes out. And that sometimes just makes us, like, feel great, like you want to high-five the first person you see when you come out of the toilet.
ZOMORODI: (Laughter) Has making this episode changed the way that you approach your own bathroom time, Jen? Is that too personal a question to ask you on public radio?
GUNTER: You can ask me anything. I, like...
GUNTER: Seriously, I have, like, no shame. I'm the person that when, like - well, back in the before time, when you used to try on bras in the department store, I'd just, like, walk out of the change room going, does this one fit?
GUNTER: So I think - I mean, I knew - I would say I knew most of the medicine. But I've always been a fiber evangelical, but I've certainly even doubled down more. Like, fiber is the way.
ZOMORODI: Fiber is the way.
GUNTER: Fiber is the way.
ZOMORODI: But don't go too crazy, right?
GUNTER: Well, you can, yeah. I mean, you can. I have on occasion found out that sometimes you can overdo it and get a little gastric distress. But when your stool moves along as it should, when it's not hard and scratchy, you lower your risk of getting hemorrhoids. And no one is ever happy with hemorrhoids.
ZOMORODI: No. OK, for those poor souls who don't know, why do we need fiber? Why is fiber so important? What does it do?
GUNTER: Fiber - ooh. People should talk about fiber like it's sexy 'cause it is. It's good for your body. One, it's really important because some fiber function is prebiotics. So for your colon, it helps you produce more good bacteria. Fiber draws water into the stool, making it softer, and then it's less scratchy when it comes out. Think of it like a sponge, a poo sponge. That's what fiber is. It's a poo sponge.
ZOMORODI: Do I have to? Like...
ZOMORODI: All right.
GUNTER: It's a great way to think about it. We're giving it an upgrade.
GUNTER: So fiber draws water into the stool, and that increases the bulk. And the bulk of the stool helps stimulate the colon to move the stool along.
ZOMORODI: So, you know, listening to you, I feel like we need to have, like, a call-in show or something. But what's your advice for making sure we ask our doctors the right questions? Because we need to be more fearless, too - right? - about bringing up issues that we might feel, oh, it's nothing or we feel squeamish about it or, you know, it's embarrassing. It's too - it's a human, right?
GUNTER: Well, I think - you know, I hate to put the onus on the patient because the doctor should be creating a welcoming environment for that. A lot of things in medicine occupy this in-between, this land of in-between where, you know, how to have a bowel movement isn't really, like, a medical problem.
GUNTER: But if it's not done right, it can be, right? So it's the same thing, like, with, like, how to wash your vulva. It's not - that's not really, like, medicine. But if it's done wrong, it is. So, you know, these are areas I think medicine needs to step up. It's like practical information people need so they can live their lives. It really should be part of health maintenance and disease prevention.
ZOMORODI: So let's say someone is thinking, well, it's not really a problem, at least not yet, so I'm not going to bother with going to the doctor's office. But then how can people find the right health information online?
GUNTER: Yeah. I mean, I think it's natural for people to want to research what's going on with their bodies online. You know, write down what's bothering you or what's concerning you, and think about what organ system you might think that involves. So, for example, if it's your poo, you're having a problem having a bowel movement, I would go to the American Gastrointestinal Association (ph), and then I would see what the experts have to say. Or the American Academy of Family Physicians - great place to start. You know, or if it's an OB-GYN question, start with, you know, the American College of OB-GYN. I think people forget that medical professional societies actually have great information online. That's a good place to start. And the National Library of Medicine and the Centers for Disease Control - they all have great information.
ZOMORODI: Can I just ask one thing that I've been wondering might be adding to this problem of lack of information about our bodies - is, at least in my experience, how specialized Western medicine has become. Like, if you go to see a podiatrist, they are definitely going to say, like, yup, it's a foot problem, as opposed to maybe it's a problem with, you know, your back or other ways that you carry yourself. Like, we don't treat the body very holistically here in the United States. Is that part of the problem? And - I don't know - do you see this changing at all as we look forward into the future?
GUNTER: Yeah. So I think that one of the root causes of many problems is the lack of investment in primary care. You know, we have these amazing family physicians, these amazing pediatricians, you know, these amazing front-line doctors who are not subspecialized. Their specialty is all of you, right? And how can they look after all of you in 15 or 20 minutes?
ZOMORODI: No, right.
GUNTER: So to me, one of the root causes of problems, certainly in North America, is this idea that we are fairly well situated to manage acute problems. You have a sore throat, you come in, you get checked for strep throat. You break your toe, you come in, you get your toe splinted. You know, you have this acute problem, and you come in and get it fixed. But many of us also then get stuck in this idea that problems can be fixed. But a lot of medicine is chronic care, right? It's things that don't go away with a pill or a surgery. Or maybe those things can help, but they're part of the long-term management. And we need to invest in systems that account for that.
ZOMORODI: Going back to the debunking of health myths, your specialty, how much do you worry that the - we're sort of entering a period that is ripe for more of this, considering the sort of post - hopefully post-COVID era where we're talking about long-haul symptoms? We don't know a lot about it. There are starting to be studies, but there aren't that many. It seems like there are going to be a lot of very vulnerable people looking for answers to feel better for a very long time to come.
GUNTER: Yeah, I think that is definitely ripe for charlatans to take advantage of it. I think also, too, you know, many people who have unstudied medical conditions, and certainly something like long COVID is something that is obviously unstudied, in part because it's so new - I think that a lot of times, doctors really just also need to say, I don't know; I don't have an answer, instead of brushing somebody off as, no, that can't be or, let me doctor-splain (ph) that to you.
When I'm honest - because I deal with chronic pain every day. I deal with a lot of conditions that are - that don't have easy fixes. And sometimes I sit down with people, and I sort of say, yeah, that sucks. You are right. We don't have this information. You are right. And I think that sometimes people want to hear that. And I think when people have difficult illnesses or illnesses that don't have answers, they get that you might not have an immediate cure. But when you say that - I don't know, but let's work on this together - I think that's welcoming. And I - so I think medicine has to figure out how to be more welcoming, how to advocate for studying things, how to look at the way we allocate research funds to make sure that we're bringing everything to the table. One thing the pandemic has shown us is that if you throw a lot of money and a lot of smart minds at things, you can solve a difficult problem pretty quickly. That's kind of a hopeful thing.
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ZOMORODI: Thank you again to Dr. Jen Gunter for spending the hour with us. You can find "Body Stuff With Dr. Jen Gunter" wherever you listen to podcasts.
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ZOMORODI: This episode was produced by Christina Cala and Matthew Cloutier, and it was edited by Sanaz Meshkinpour. Our TED Radio production staff also includes Jeff Rogers, Rachel Faulkner, Diba Mohtasham, James Delahoussaye, J.C. Howard, Katie Monteleone, Janet Lee and Fiona Geiran. Our audio engineer is Daniel Shukin (ph). Our theme music was written by Ramtin Arablouei. Our partners at TED are Chris Anderson, Colin Helms, Anna Phelan and Michelle Quint. I'm Manoush Zomorodi, and you've been listening to the TED Radio Hour from NPR.
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