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Gut feeling

Finally, a book that breaks down the science of our gut

By Aditya Misra
Published: Thursday 31 December 2015
Illustration: Sorit

Giulia Enders
Speaking Tiger | 271 pages | Rs 869

EVERY TIME we go to the loo, it’s a masterly performance,” writes Giulia Enders in her hugely successful book, Gut. The line quite accurately captures the author’s fascination with the subject. Enders says the gut is the most underrated organ of the human body and makes a compelling argument. Of the three main systems of the human body—the nervous system, the cardiovascular system and the digestive system—the “masterpieces” of the first two, brain, in the case of the nervous system, and heart, in the case of the cardiovascular system, are held in great regard. But the gut, which is no less wonderful and important, is not given due credit. “The gut’s network of nerves is called the ‘gut brain’ because it is just as large and chemically complex as the grey matter in our heads,” she says.

However, it is the bacteria (weighing nearly two kilogrammes) in the gut, which are at the centre of her attention. Among other functions, they counter diseases, digest food, generate energy, manufacture hormones and are responsible for our mood. In fact, the connection between the gut and the brain is an emerging field of study and gut microbes might hold the key to several diseases, including psychiatric disorders. “Anyone who suffers from anxiety or depression should remember that an unhappy gut can be the cause of an unhappy mind,” she writes. However, this connection is yet to be proven and the hypothesis has even received criticism for being far-fetched.

What would make a large section of the Indian population happy, and smug, is Enders’ wholehearted approval of the squatting posture for emptying the bowel. She says that the “closure mechanism of our gut is not designed in such a way that it can open the hatch completely when we are seated.” (See ‘The gut influences...,)

The book also explains how the gut is connected to food allergies, constipation, vomiting, diarrhoea and acid reflux. It also has several interesting nuggets about bodily phenomena we witness every day but do not notice or understand. For instance, the rumbling sound we think the stomach makes when we are hungry is actually the sound of the cleaning process going on inside the small intestine. The book explains why the eyes appear swollen when we wake up in the morning or why is there a sudden rush of saliva in the mouth right before we are about to vomit.

Enders has also given pieces of information that are in contrast to conventional wisdom and theories. For instance, she says that the much maligned cholesterol is necessary for the body. “If it weren’t for cholesterol, we would have no sex hormones, no vitamin D,” she writes. She also says that compared to olive oil, butter is better for deep frying since it is much more stable when exposed to heat. The book has a generous sampling of such information, which ensures that the reader is constantly amused and hooked.


Squatting has been the natural pooing position for humans since time immemorial. The modern sitting toilet has existed only since indoor sanitation became common, in the late eighteenth century. But such 'cavemen did it that way' arguments are often met with distain [sic] by the medical profession. Who says that squatting helps the muscle relax better and straightens the faeces highway? Japanese researchers fed volunteers luminescent substances and X-rayed them while doing their business in various positions. They found out two interesting things. First, squatting does indeed lead to a nice, straight intestinal tract, allowing for a direct, easy exit. Second, some people are nice enough to let researchers feed them luminous substances and X-ray them while they poo, all in the name of science. Both findings are pretty impressive, I think.

Haemorrhoids, digestive diseases like diverticulitis, and even constipation are common only in countries where people generally sit on some kind of chair to pass their stool. This is not due to lack of tissue strength, especially in young people, but to the fact that there is too much pressure on the end of the gut. Some people tend to tense up their entire belly muscles when they are stressed. Often, they don't even realize they are doing it. Haemorrhoids prefer to avoid internal pressure like that, by hanging out of the anus. Diverticula are small, light-bulb-shaped pouches in the bowel wall, resulting from the tissue in the gut bulging outwards under pressure.

Of course, the way we go to the toilet is not the only cause of haemorrhoids or diverticula. However, it remains a fact that the 1.2 billion people in this world who squat have almost no incidence of diverticulosis, and far fewer problems with hemorrhoids. We in the West, on the other hand, squeeze our gut tissue till it comes out of our bottoms and we have to have it removed by a doctor.

`The gut influences our mood'

Giulia Enders is a two-time scholarship winner studying medicine at the Institute for Microbiology in Frankfurt, Germany. Her presentation of Darm mit Charme (Gut Charm) won her first prize at the Science Slam in Berlin and went viral on YouTube. Her book on the gut is a bestseller. Enders speaks to Down To Earth about the less discussed topic. Excerpts

What made you choose an unusual subject such as the gut?

When I was 17, I had really bad dermatitis. I wanted to know more about my body and not feel a victim to its ways. When I read about the gut I was extremely surprised that it is way cleaner than I always believed it to be: seven of the approximately eight metres don't have anything to do with faeces, but are clean and odourless most of the time. Also, I was stunned how sensible and responsible it is for so many things in my life-not only food, but my mood, my immune system and also my hormones.

How different is this organ from others?

It is very pretty when you zoom in! The small intestine looks very much like satin under the microscope. If we would roll out all the wrinkles and frill, our gut would be around seven kilometres.

Why do people have such a difficult relationship with their intestine?

In Germany this isn't an easy topic to discuss. So I was very glad when people wrote me that they almost couldn't believe their ears when their catholic grandma put the book on the table and said: `So I think we must talk about this gut book. I discovered I sat wrong on the toilet for 74 years today!' Laughter is a great tool to let go of false shame.

How do the brain and intestine work together?

The scientific hypothesis here is: our brain is a very isolated organ. It is within its bony skull and has a very thick membrane to filter every drop of blood before it may nurture the brain cells. This isolated organ needs to know how we, as a whole, are doing in order to create a mood. Our gut has very relevant information for this: it knows not only all the molecules from our foods, but also what two-thirds of our immune system are doing, what the 100 trillion bacteria are up to, and produces around 20 hormones of its own.

Recent research on mice shows how to make them more courageous, or better in studying new things via different gut bacteria. There are also new results of experiments on humans. An American research team showed that the human brain patterns change after a four-week intake of special bacteria, especially in the area of emotion-processing.

To what extent does the intestine influence our mood?

We know only some pieces of the puzzle. For example, people with chronic inflammatory diseases of the gut or irritable bowel syndrome have a higher risk of getting anxiety disorders or depression. Research shows how to improve our mood with gut bacteria. Feeding some of your good microbes well is a smart move. The hard-to-digest grain-cereal is not always the best, but consumption of water-soluble fibres like asparagus, cold potato and onions could help. But more research is needed to specify the extent to which our gut can influence our brain.

How should we treat our bowel?

Get a smarter body feeling using science. Knowing that food takes two to three hours to being taken up in the blood can help you calculate: how do I feel two to three hours after a meal? You can experiment with foods such as probiotics and prebiotics. I am a supporter of self-experiments, as long as they don't harm you.

How did you prepare to write this book?

I read tonnes of papers and then started playing with the content. My sister was always a great inspiration since she is a scientific-designer. When I got stuck, she would help me see things from different perspectives. I love her illustrations in the book. In my eyes, she has a flawless style.

How has the book changed your life?

Honestly, I didn't think so much about success when I was writing the book. I just thought: more people need to know and this has to be as good as possible. I was very afraid of German scientists; whether they would discard me. But so far, I have got great reactions. Two of my professors invited me to give a 10-minute talk in their lectures.

What's your next book?

First, I hope to be a good doctor. If there is something that I really want people to know, then I could imagine doing small projects with my sister again. But I will be very happy if I could put this book out in the world and continue with my medical work.
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