The Gurgling, Growling History Of The Gut

IRA FLATOW: This is Science Friday. I’m Ira Flatow. When people get together and talk about their aches and pains, I have found that chances are the talk turns to tummy. The stomach remains a subject of mystery and intrigue. After all, it’s nearly impossible to ignore its gurgles and growls. And if you’re a frequent listener to this show, you’re familiar with our fascination with the guts microbiome, the constellation of trillions of microbes thriving in our bodies, and that our stomachs have some of the same neuroreceptors, as our brains, sort of a second brain, so to speak.

You know that gut feeling? Well, my next guest has traced the changing cultural and scientific understanding of the gut. Doctor Elsa Richardson is author of Rumbles, The Curious History of the Gut. She’s the co-director of the Center for the Social History of Health and Health Care at Strathclyde University, based in Glasgow, Scotland. Welcome to Science Friday.

ELSA RICHARDSON: Thanks so much for having me on, Ira.

IRA FLATOW: In the book, you write about not just the medical history of the gut, also its cultural history. How have the metaphors we use to describe the gut shaped our understanding of it?

ELSA RICHARDSON: Well, I think that’s what really got me interested in the gut as a topic. So I’m a medical historian by training, but my interest tends to lie in where medicine and ideas about health sit it culture. And what I noticed when I was looking into the history of digestion and looking into the history of diet, was how dramatically the metaphors we have used to describe, think about our stomachs have changed over time. So my area of specialism is the 19th century, 19th century British history, and one thing that I found really odd in a way, was the way that the metaphors then that attached themselves to the stomach were overwhelmingly negative.

So I think today, we tend to talk about our stomachs as these kind of beautiful, blooming gardens that have to be tended and carefully managed ecosystems within, maybe. Whereas, in the 19th century, the metaphors and the language associated with the gut was much more confrontational. So you have physicians in the middle of the century describing the gut as an enemy within, as a foe that had to be conquered, or this kind of irascible creature that lived within you, which you fed and you tried to placate, and yet, it still acted against you. It still gave you stomach aches and terrible pains. Many of the sources that I was looking at and citing were from the medical community, where physicians who were talking about and describing the stomach using really florid language, kind of quite unusual imagery.

IRA FLATOW: Possibly some of the mystery of the gut revolves around historically, it was harder to study as compared to other body systems, right?

ELSA RICHARDSON: Yeah, I think that’s part of why the metaphors around the gut are so rich and so diverse. One of the reasons is that for so long, the stomach really remained something of a medical mystery. When dissection became part of medical education, these dissection manuals would often describe the need to examine the stomach first because it’s the organ which will decay quickest.

So there’s this sense in which outside of the body, the stomach doesn’t really make sense or it doesn’t make sense for very long. Added to that, there is throughout medical history, especially before modern medicine, the gut is also so important to treating the body, to diagnosing disease and to managing health, generally. So before we have antiseptics, before we have ways to anesthetize patients, opening up the body is a really dangerous procedure. That leads to the question of what other interventions can you make into the body?

And one of the major ones is through diet. It’s through the gut. So the gut is both a way that the body’s health can be treated and maintained. But it’s also diagnostic space. So many doctors would examine the feces for clues as to what was going on in the interior of the body.

IRA FLATOW: Yeah, and it’s still talked about having a microbiome that’s healthy. And your diet might be able to impact that.

ELSA RICHARDSON: Yeah, absolutely. And part of what is so interesting for me as a historian of medicine about– it’s not anything about diet– is that it is an organ of the body which has resisted medical authority in interesting ways. So on the one hand, where there are other parts of the body where medical expertise is paramount, so you think about perhaps going to, let’s say, a cardiologist and a cardiologist tells you, “listen, you have to take these particular pills in order to stop yourself from having a heart attack.” You would be relying on the expertise of that physician. And you probably likely do what they say.

However, the stomach is this space in which there is a lot of competing different forms of knowledge and competing forms of expertise. So you think about, the way that perhaps you may see a nutritionist if you have particular gastric problems, but you might also look to forms of household wisdom. You might also look to, I don’t know, the advice of your grandmother about what to–

[LAUGHTER]

–What’s good to eat and what’s not.

IRA FLATOW: But we’ve had big advances in understanding the gut, and I’m talking about the discovery of the enteric nervous system. There are all these nerves down there. How was it discovered that we have this sort of mini brain there?

ELSA RICHARDSON: Part of what’s so interesting about the enteric nervous system and so, I think, must have been mind blowing to discover at the time, it’s not only that there are nerves down there, but it is also that it is kind of truly, in a way, a second brain, in that what was discovered about the enteric nervous system when it was mapped by physiologists in the latter part of the 19th century, was that it’s also able to think for itself.

The enteric nervous system can act outside of the central nervous system. So I think part of what the enteric nervous system might force us to question is exactly what kind of thinking different parts of the body are capable of doing. Because, obviously, the enteric nervous system and the gut don’t think in the same way as the brain thinks. But part of what this suggests is that there is a kind of cognition going on down there.

IRA FLATOW: Yeah. Because most of us are keenly aware of the connection, I think, between the gut and the brain. You get butterflies in your stomach, you’ll have anxiety stomach aches. That relationship between mind and gut has changed over time, hasn’t it? I mean, we sort of realized it, but now we know more medically, scientifically how that happens.

ELSA RICHARDSON: I think it’s absolutely changed over time. But what I find consistent through the history of the gut is that it’s basically as long as we have been interested in the brain, or as long as we’ve been interested in the stomach, we have been convinced of a link between the two of them. So I think that modern science is doing wonderful work in terms of mapping that connection.

So through the enteric nervous system, through the kind of neurons in the microbiome that you mentioned in the opening, and also through the vagus nerve, that direct highway between the gut and the mind. So there’s a great deal of work being done just now in terms of trying to understand exactly what the kind of mechanisms are which facilitate that connectivity.

IRA FLATOW: I know you’re a historian of science, and I want to get into some history because it’s fascinating. You write about a Victorian era physician, doctor William Arbuthnot Lane, who is obsessed with constipation and curing it. Tell me a bit about his work and his theory of the gut? And I hope I got his name right.

ELSA RICHARDSON: So William Arbuthnot Lane is a fascinating figure. So he was an extremely well-respected surgeon working in London around the end of the 19th century and the beginning of the 20th century. He was at one point surgeon to the King. So he is a Sir William Arbuthnot Lane, actually.

IRA FLATOW: Excuse me, I didn’t mean to leave that out.

ELSA RICHARDSON: Excuse you.

IRA FLATOW: Yes.

ELSA RICHARDSON: He becomes obsessed in the latter part of the 19th century with the problem of constipation. And one of the reasons that he becomes so interested in this problem is because of the theory that– it’s not his theory, but which was very present in this period called the theory of autointoxication. And so the idea of autointoxication basically posits that material, waste material, sitting in the bowel for too long will begin to fester, grow putrid, and begin leaking all kinds of nasty bacteria and toxins back into the rest of the system.

So this is, as you can probably tell, partly a product of the rise of bacteriology as a field. So this is the language of good bacteria and bad bacteria. It’s also a product of a generalized anxiety in the latter part of the 19th century about the problem of positiveness. The problem of not being able to go. And William Arbuthnot Lane suggested, or perceived that this was, in fact, a much bigger problem than physicians had previously acknowledged.

And what he suggested was that all of these kind of toxins that he thought were leaking back into the body from the guts were causing all kinds of problems. So he attributed things like infertility, to autointoxication, fatigue, muscle wastage, neurasthenia, but also, quite dramatically, things like cancer. The failure to empty your bowels at least once a day was something which he viewed as absolutely imperiling your health. He would advise his patients to modify their diet to perhaps take up different forms of exercise.

But in the most severe cases, he began removing large sections of their colons. So either chunks of colon, but also sometimes full colonectomy’s in the most severe cases. And he performed hundreds of these surgeries, mainly on women– it should be noted– towards the end of the 19th century and the beginning of the 20th century, until finally he was pulled up in front of the British Medical board and was eventually struck off the British Medical register. So he had this kind of quite a dramatic kind of fall from grace, really, all because of this quite monomaniacal obsession with constipation.

IRA FLATOW: Well, I want to get into that part you said about women. I mean, you write about how throughout history, women have been seen as being predisposed to gut issues, right?

ELSA RICHARDSON: Yes.

IRA FLATOW: Why is that?

ELSA RICHARDSON: I think it’s a really complicated question. So, I mean, we think about the way that even– I don’t know what it’s like over in the United States, but in Britain, medication, laxatives, but also things like yogurts with probiotics, which are meant to improve gut health, are really predominantly marketed at women.

IRA FLATOW: I didn’t know that.

ELSA RICHARDSON: So we live with that association today. And apparently, according to figures, women are more prone to constipation than men. Now, this may have a physiological cause. It may be that it’s associated, perhaps, with the hormonal changes or menstruation. However, it might also be that women today just report, or more willing to admit, perhaps, to being constipated than men are.

But what is interesting is that throughout history, there has been this quite sustained and complicated connection between women and constipation. So when William Arbuthnot Lane was working in the 19th century, he suggests that part of the problem is a female prudishness around matters of the toilet, that what is happening is that women have been raised in stuffy Victorian households, that they are too proper and that this is somehow impeding their toileting regularity.

What he also suggests, and what is consistent also throughout history is this kind of connection that is made between women’s reproductive capacity and her digestive health. So for William Arbuthnot Lane, one of the ways that he worries his female patients is by saying, “look, if you are constipated, this is going to impact, one, your ability to get a husband.” So you will have, according to him, sallow skin and be of a kind of crabby disposition, much less likely to get wed. But also that even if you are able to somehow bag a man, you will be unable to bear children because there’s this constipatedness in your system is going to impact your reproductive health.

IRA FLATOW: I only have a few minutes left, but I don’t want to let you go without talking about one of the weirdest pieces of research in your book is about how what’s in your stomach relates to what we dream about. Really?

ELSA RICHARDSON: That came out of a survey which was conducted by the British Cheese Board– boom, boom– which suggested that eating certain types of cheese before bed would produce particular kinds of dreams. So Red Leicester causes weird dreams. Brie invokes kind of celebrities to appear in your dream. This was a survey that was undertaken in Britain, probably as a piece of wild marketing material. But it did speak to a quite long standing association between the belly and the dreaming mind.

The research that I looked into more closely was looking at the way that medieval dream theorists and dream interpreters talked about digestion. And these dream theorists proposed that a number of things could happen. So, one, food digesting in your belly could send up vapors to your brain, which would then produce particular dreams or visions. And based on that, they suggested that dreams that were had in the early part of the morning were more likely to be of a spiritual or a kind of divine nature than dreams which were experienced in the early part of the evening, let’s say.

And the reason for that was that by the early morning, your stomach would have digested all of the food that was in it. There would be nothing sitting there festering anymore, and that therefore, your dreams would not be clouded by these vapors emitting from the stomach. Now, obviously, we don’t tend to think about dreams in exactly those terms anymore. But I think we still sustain some connection between, perhaps, having, I don’t know, overindulged the night before and then suffering weird nightmares or terrors.

IRA FLATOW: Yeah. I remember when I was a kid, my mother would say, don’t eat all that, you’re going to have nightmares.

ELSA RICHARDSON: Yes. Absolutely.

IRA FLATOW: When you go to sleep. I don’t think there’s any empirical evidence that’s connecting any of these dreams to food, is there?

ELSA RICHARDSON: A folklorist by the name of Caroline Oates has done some research into tracing the cheese dream, but the cheese dream across cultures. So in Britain and North America, we are very likely to report that after eating a strong piece of cheese, we have weird dreams, let’s say. Whereas, in other countries, namely Southern European countries, so thinking of France, Italy, places like that, people do not tend to report any association between having eaten a kind of cheese and having a weird dream.

And those countries are not known as kind of cheese-avoiding nations. Without postulating exactly what that tells us, I think that part of what it describes is the way that– yeah, that dreams and the dreaming mind cannot sit outside of culture.

IRA FLATOW: Well, in this case, the cheese stands alone, as we used to say.

[CHUCKLING]

Doctor Richardson, thank you for taking time to be with us today and good luck with your book.

ELSA RICHARDSON: Thank you so much for having me, Ira. It was a real dream.

[LAUGHTER]

IRA FLATOW: Doctor Elsa Richardson, author of Rumbles, The Curious History of the Gut, and she is the co-director of the Center for Social History of Health and Health Care at Strathclyde University, based in Glasgow, Scotland.

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